Appropriate shock while awake

Published on 2017-05-21, by DR Marc Strik, CHU Bordeaux, United States.

Trace category: 
EGM
Device/Field: 
ICD
Company: 
Abbott

47 year old type 1 diabetic and anterior infarction in 1997 with LVEF 20% and ICD implantation in 2010 (St. Jude Medical AnalyST Accell VR). received his first shock ever (see attached episode). He felt dizzy and laid down on his bed when he received the shock while he was fully awake.

Any recommendations to prevent future shocks during consciousness?

DR Guillaume Viart

Sun, 28/05/2017 - 20:40

Hello Dr Strik,

That's quite a fast VT and a low EF to enable a longer period before shocking.

Maybe allowing ATP during charge could help converting the arrhythmia to sinus rhythm.

Another solution would be to give him Amio to slow down the VT (that seems to be quite monomorphic) and allow it to be treated by ATP in the VT zone.

What did you end up doing ?

DR Marc Strik

Thu, 01/06/2017 - 16:13

Unfortunately ATP during charge is not yet possible with this model.

During admission he again developed VT, this time hemodynamically instable.

Therefore we transferred him to an EP-centre for ablation.