Cardiac implantable electronic device discharge during intrathoracic tumour radiofrequency ablation

Dear Editor,
Techniques like radiofrequency (RF) ablation are emerging as new developments in the treatment and palliation of cancer. Cardiovascular implantable electronic devices (CIEDs) are increasingly used as treatment for the prevention of sudden cardiac death in the same patient population. CIEDs are indicated for primary prevention of sudden cardiac death in patients with prior myocardial infarction or systolic heart failure combined with decreased left ventricular ejection fraction. The devices are also indicated as secondary prevention for patients with documented cardiac arrest from sustained ventri­cular tachycardia or ventricular fibrillation. In many cases, a CIED is used as the first-line prophylactic therapy in patients demonstrating marked ventri­cular dysfunction [1]. CIEDs are permanent devices which utilise several lead options to promptly correct a patient’s aberrant rate or rhythm [2].
Patients with CIEDs, however, are at a surgical risk due to procedural electromagnetic interference (EMI) of intraoperative devices [3]. CIEDs may detect EMI causing disruption of the device and resulting in the delivery of an inappropriate shock [4]. In pacemaker dependent patients, EMI may prevent the CIED from sensing asystole. Numerous studies and case reports suggest that RF ablation procedures are associated with a risk of EMI and may cause severe adverse outcomes. Here we present a case of a palliative tumour RF procedure in a patient with a CIED that resulted in an inappropriate delivery of a defibrillating shock. We also present a review of literature of similar cases previously reported.

CASE PRESENTATION

B.C. is a 62-year-old male with history significant for diabetes, paroxysmal atrial fibrillation, hyper­trophic cardiomyopathy with moderate systolic dysfunction and diminished diastolic dysfunction, as well as prior ventricular tachycardia status post a single-chamber implantable cardioverter-defibrillator placed seven years prior. The patient presented for RF ablation of a right apical lung mass secondary to metastasis of pancreatic cancer. Preoperatively, his CIED was not interrogated nor deactivated. Following induction of general anaesthesia and onset of RF, ventricular bigeminy was noted on ECG; however, the patient remained haemodynamically stable. The patient was noted to experience a body convulsion; activation of the automated implantable cardioverter-defibrillator (AICD) was suspected and a magnet was...


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