ABSTRACT
Patients implanted with left ventricular assist devices (LVAD) may have implantable cardioverter defibrillators (ICD) implanted for sudden cardiac death prevention. This opens the possibility of device-device communication interactions and thus interferences. We present a case of such interaction that led to ICD communication failure following the activation of an LVAD. In this paper, we describe a practical solution to circumvent the communication interference and review the communication links of ICDs and possible mechanisms of ICD-LVAD interactions.
Subject(s)
Defibrillators, Implantable/adverse effects , Electromagnetic Fields , Heart-Assist Devices/adverse effects , Telemetry , Equipment Design , Equipment Failure Analysis , Humans , Male , Middle Aged , Shock, Cardiogenic/etiologyABSTRACT
Clinical diagnosis of chronic or slowly progressing pericardial effusion with impending tamponade remains a challenge, particularly when classical physical signs are subtle or absent. A high index of suspicion should be entertained in such cases in the appropriate setting even when the clinical signs and symptoms are missing. We present two cases where the pericardial effusion was missed in the emergency department due to subtle clinical features or mistaken for a more familiar "look-a-like" presentation. A review of the literature and an analysis of various clinical parameters of published cases were performed. It is pivotal that physicians should not only be aware of the limitations of the traditional clinical signs, but also be familiar with the use of other subtle findings and the importance of other modalities that may potentially enhance the sensitivity in diagnosing chronic pericardial effusion impending tamponade.
