Thursday, March 18, 2010

A Case of an Appropriate Inappropriate Shock

He was 60 year old man who underwent implantation of an implantable cardiac defibrillator (ICD) implant approximately 3 years prior who was returning to the clinic for routine follow-up. He felt well and had no other complaints.

He was connected to the EKG and the programmer's wand placed over the device. I interrogated his device and when the initial screen appeared, there it was: a single shock from his device, received two weeks ago.

"Mr. Smith, are you aware that you had an ICD shock about two weeks ago?"


"Why didn't you call us?"

"I don't know."

"Did it bother you?"

"Not really."

"Why not?"

There was a pause. I looked up from the programmer and took a quick look at him. He was looking away. Instantly, I realized the answer.

"Never mind," I answered. "Here, I'll just change the VT detect rate."

"No, doc, please don't. Leave the settings as they are."

"Are you sure?"

"Absolutely." He looked at me as I doubted him. "Seriously doc, I mean it."

"How come?"

"She liked it."



master of the obvious said...

Ive seen the same thing; A question about the shocks, similar times at night, a smirk, and the jealousy that hetting more action than me.

Im impressed that a MD actually checks his own devices and knows how to. Kudos.

A Rep

Marco said...

Give her a remote control!

Danimal said...

Hey doc, can you give a discount for those of us who want one for purely recreational reasons?

prsTM said...

Ok, someone has to ask: just what did it do for her?

Anonymous said...

And, for those of who aren't cardiac MDs, an ICD shock means...what?

Kim said...

Gee, maybe we are implanting them in the wrong place.... : Df

Too funny!

Anonymous said...

This story is too cute -- literally, to the point where it seems contrived. But okay, I'm sure it could happen. But besides the fact that this entry seems to me to violate a patient's privacy (you think he couldn't recognize himself as the patient?) it seems to fit too nicely, Dr. Wes, with your hey! they're just parta the whole fabulous package! attitude toward ICD shocks. And you don't even state clearly whether it was an appropriate shock -- or, since you were so willing to raise the defib rate, whether the device was programmed optimally in the first place. Sorry if I sound cranky, but your ICD-fanboy attitude genuinely grates. Some of us, especially new-generation expanded-criteria ICD owners, are aghast that EPs have become so quick to recommend this technology. This is not a benign technology. For many people, it's a burden as often as it can become a gift. And Anonymous, in answer to your good question, an ICD is implanted, sort of an "explosive" pacemaker, and a shock from it can make you bark like a dog and then it can knock you off your feet or out of bed or down the stairs, etc. Shocks can induce PTSD. They can happen as a "storm" -- again and again and again. And shocks are "bad" -- not lifesaving, but shocks for the wrong reasons, or because of a device malfunction -- more often than they are life-saving. Cute Story aside, they're not fun and not funny. Dr. Wes, you are a smart, well-intentioned guy, but I wish you were more thoughtful about ICDs.

DrWes said...


While the circumstance was very real, aspects of this the "story" were altered to avoid any potential for compromise of patient privacy. As noted by "master of the obvious," I'm not the only one who has heard of such an incident.

Your point about PTSD and ICD's is valid. Shocks are perceived differently by people, ranging from being completely asymptomatic, to exceedingly painful. Repetetive ICD shocks can have long-term psychologic consequences.

Regarding my ICD-fanboy attitude, if I perceive that these devices do more good than harm for patients and that grates on you, well, you're free to read elsewhere. I can assure you many of may patients can thank these devices for allowing them to keep reading this blog.