Emergency department management of patients with automatic implantable cardioverter-defibrillators

Abstract

The case of a patient with idiopathic dilated cardiomyopathy and complex ventricular arrhythmias who underwent placement of an automatic implantable cardioverter-defibrillator (AICD) and experienced inappropriate shocks during atrial fibrillation is presented. On presentation to the emergency department, the patient had experienced approximately ten device discharges over six hours. ECG revealed atrial fibrillation with a rapid, wide complex ventricular response. Initial management consisted of IV verapamil for rate control followed by deactivation of the AICD. The patient was subsequently hospitalized for treatment of atrial fibrillation. Inappropriate device discharges, a frequently reported AICD-associated complication, are discussed.