loading page

Body Piercing with a Metallic Tongue Ring Resulting in Ineffective ICD Shocks: “Heart to Mouth”
  • +3
  • Manavotam Singh,
  • Vijaywant Brar,
  • Nebu Alexander,
  • Rustin Tashayyod,
  • Susan O'Donoghue,
  • Seth Worley
Manavotam Singh
MedStar Washington Hospital Center

Corresponding Author:manav.singh07@gmail.com

Author Profile
Vijaywant Brar
MedStar Washington Hospital Center
Author Profile
Nebu Alexander
MedStar Washington Hospital Center
Author Profile
Rustin Tashayyod
Medtronic Inc Washington DC
Author Profile
Susan O'Donoghue
MedStar Washington Hospital Center
Author Profile
Seth Worley
MedStar Washington Hospital Center
Author Profile

Abstract

Left ventricular assist devices (LVADs) provide circulatory support to patients with severe left ventricular systolic dysfunction. Many such patients have a pre-existing implantable cardioverter defibrillator at the time of their LVAD surgery. LVAD implantation can alter ICD lead parameters including R wave sensing, RV capture threshold, and impedance. These changes can in turn affect the ability of the ICD to successfully treat malignant ventricular arrythmias. In most patients who present with ineffective ICD shocks, the failed shock is assumed to be secondary to the patient’s severe cardiomyopathy. Especially the role of physical examination in such patients is often minimized. In our patient a thorough history and history guided physical examination, led us to the root cause of his failed ICD shocks. Our patient was noted to have a metal tongue ring, which was the likely cause of his ineffective ICD shocks. Our case highlights the importance of a comprehensive history and physical examination.