SUBCLAVIAN CRUSH SYNDROME AND INAPPROPRIATE SHOCKS IN PATIENT WITH IMPLANTABLE CARDIOVERTER DEFIBRILATOR

  • Irena Misic University Clinic of Cardiology,Clinical Center Mother Theresa, Skopje, North Macedonia
  • Filip Janusevski University Clinic of Cardiology, Clinical Center Mother Theresa, Skopje, North Macedonia
  • Jane Taleski University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje,North Macedonia
  • Dejan Risteski University Clinic of Cardiology, Clinical Center Mother Theresa, Skopje, North Macedonia
  • Lidija Popovska University Clinic of Cardiology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje,North Macedonia

Abstract

Subclavian crush syndrome may occur when the lead from cardiovascular implantable electronic device (CIED) is trapped between the clavicle and the first rib and the insulation layer is damaged, or conductor has been fractured. This complication carries an even greater risk if it involves a defibrillation electrode.
Case report: We describe a case of a 68year old male patient with sudden onset of Implantable cardioverter defibrillator (ICD) activation- shocks delivery, more than ten times in the period of two hours, right before the admission to the emergency unit department. His ECG on admission shows rhythm of pacemaker with normal ventricular capture. The device interrogation revealed 53 episodes of ventricular fibrillation- false detection and delivery of multiple inappropriate shocks. Low impedance was detected of pace/sense electrodes <200Ω, rise in shock impedance, ventricular oversensing episodes, and high pacing threshold. Due to Inappropriate ICD therapy the detection was turned off. Radiography findings have shown interruption of electrode – continuity in a position corresponding to subclavian crush syndrome, thereby implantation of the new system was indicated. The intervention of new system implantation was performed without any complication in standard procedure, using left axillary vein approach. We inserted a new ventricular single coil defibrillation electrode and new ICD device. The patient was discharged in a good clinical condition. Physicians must demonstrate excellent understanding of lead designs, mechanism of lead fracture, diagnosis and management, in order to make the best decision for every individual patient. Inappropriate shocks are medical emergency and must be treated immediately. Individual approach in every patient should be mandatory.


Keywords:subclavian crush syndrome, Implantable cardioverter defibrillator, lead fracture.

References

1.Chan NY, Kwong NP, Cheong AP. Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic cutdown. Europace 2017;19:1193-1197.
2.Bongiorni MG, Kennergren C, Butter C, Deharo JC, Kutarski A, Rinaldi CA, et al. The European Lead Extraction ConTRolled (ELECTRa) study: a European Heart Rhythm Association (EHRA) Registry of Transvenous Lead Extraction Outcomes. Eur Heart J. 2017;38(40):2995–3005.
3.C.D. Swerdlow, B.D. Gunderson, K.T. Ousdigian, et al .2008 Downloadable algorithm to reduce inappropriate shocks caused by fractures of implantable cardioverter-defibrillator leads Circulation, 118:2122-2129.
4.C.D. Swerdlow, S.J. Asirvatham, K.A. Ellenbogen 2007., et al.Troubleshooting implanted cardioverter defibrillator sensing problems .Circ Arrhythm Electrophysiol, 7:1237-1261.
5.K.A. Ellenbogen, B.D. Gunderson, K.D. Stromberg, et al. 2013 Performance of a Lead Integrity Alert to assist in the clinical diagnosis of implantable cardioverter defibrillator lead failures: analysis of different implantable cardioverter defibrillator leads. Circ Arrhythm Electrophysiol, 1169-1177.
6.Charles D. Swerdlow, Jayanthi N. Koneru, Bruce Gunderson, Mark W. Kroll, Sylvain Ploux and Kenneth A. Ellenbogen.2020 Impedance in the Diagnosis of Lead Malfunction, 13:2.
7.N. Koneru, B.D. Gunderson, H. Sachanandani, et al.2013. Diagnosis of high-voltage conductor fractures in Sprint Fidelis leads Heart Rhythm, 10 :813-818.
8.Ellenbogen KA, Gunderson BD, Stromberg KD, Swerdlow CD.2013. Performance of lead integrity alert to assist in the clinical diagnosis of implantable cardioverter defibrillator lead failures: analysis of different implantable cardioverter defibrillator leads.Circ Arrhythm Electrophysiol.  6:1169–1177. 
9.Gautham Kalahasty and Kenneth A. Ellenbogen.2011. Management of the Patient With Implantable Cardioverter-Defibrillator Lead Failure.Circulation.123:1352–1354.
10.U. W, Moore HJ, Karasik PE, Franz MR, Singh SN, Fletcher RD. 2009.Management strategies when implanted cardioverter defibrillator leads fail: survey findings. Pacing Clin Electrophysiol.  32: 1130– 1141.
11.Scott Beau , Stephen Greer ,Christopher R Ellis, Jeffrey Keeney, Shubha Asopa, Edith Arnold, Avi Fischer.2016.Performance of an ICD algorithm to detect lead noise and reduce inappropriate shocks.pub Med.;45(2):225-32. doi: 10.1007/s10840-015-0081-6.
12.Squara F, Tomi J, Scarlatti D, Theodore G, Moceri P, Ferrari E. Self‐taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access. 2017;19(12):2001–6.
13.Lloyd Davis, William Chik,Saurabh Kumar, Gopal Sivagangabalan, Stuart P. Thomas, PhD,  A. Robert Denniss.2021. Axillary vein access using ultrasound guidance, Venography or Cephalic Cutdown—What is the optimal access technique for insertion of pacing leads? 2021 Dec; 37(6): 1506–1511.
14.Maria Grazia Bongiorni, Charles Kennergren, Christian Butter, Jean Claude Deharo, Andrzej Kutarski, Christopher A Rinaldi, Simone L Romano, Aldo P Maggioni, Maryna Andarala, Angelo Auricchio.2017.The European Lead Extraction ConTRolled (ELECTRa) study: a European Heart Rhythm Association (EHRA) Registry of Transvenous Lead Extraction Outcomes.,40: 2995–30.
15.Amit Kumar, Vatsal Ladia, Victor Abrich, Luis Scott.2019. A Case of LV Lead Fracture in Submuscular Implant: Identify and Prevent Lead Fracture.1: 311-312.
Published
2022-12-29
How to Cite
MISIC, Irena et al. SUBCLAVIAN CRUSH SYNDROME AND INAPPROPRIATE SHOCKS IN PATIENT WITH IMPLANTABLE CARDIOVERTER DEFIBRILATOR. Journal of Morphological Sciences, [S.l.], v. 5, n. 3, p. 25-29, dec. 2022. ISSN 2545-4706. Available at: <http://jms.mk/jms/article/view/vol5no3-5>. Date accessed: 29 mar. 2024.
Section
Articles