Implantable cardioverterdefibrillators: a case report

An emergency call was placed to emergency medical services (EMS) requesting an ambulance for a patient whose implantable cardioverter-defibrillator (ICD) had fired. An advanced life support (ALS) unit arrived to find a 70-year-old male in no acute distress. The initial electrocardiogram (ECG) showed ventricular tachycardia (VT). The patient was then shocked by his ICD, which converted him back into a paced rhythm. The patient again went into VT and was shocked an additional four times by his ICD prior to the arrival of the transporting ambulance.

The ambulance crew found the patient awake and alert, and complaining only of chest pain from the ICD fring. Vital signs were as follows: heart rate 70 beats per minute and regular, blood pressure 118/80 mmHg, respiratory rate 16 breaths per minute, and pulse oximetry 99% on room air. The patient's 12-lead ECG showed a paced rhythm. The patient had a past medical history of coronary artery disease, hypertension, high cholesterol, and congestive heart failure. His surgical history included coronary artery bypass grafting and multiple cardiac stents. His medication list included clopidogrel, furosemide, amiodarone, simvastatin, and carvediol. The patient was transported to the emergency department without need for further intervention.