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Patent foramen ovale and implantable cardioverter defibrillator.

A case of patent foramen ovale opening was observed concomitantly to a defibrillation threshold determination in the setting of an internal cardioverter defibrillator implantation. The subsequent transient right-to-left shunt was confirmed by a peroperative transoesophageal echocontrast study. The underlying mechanism of this incident may be related to a transient reversal of the interatrial gradient, due to the pre-existence of pulmonary hypertension and tricuspid regurgitation, associated with ongoing mechanical ventilation and modifications of intracardiac pressures regimen secondary to the succeeding ventricular tachyarrhythmia and defibrillation. Paradoxical embolism can be an aetiology for neurologic injury during internal cardioverter defibrillator implantation.

Defibrillators, Implantable↗
PubMed1998

Implantable Defibrillator Therapy for the Elderly.

The clinical application of ICD devices in the management of patients with ventricular tachyarrhythmias and cardiac arrest is rapidly expanding and is projected to exceed 50,000 implants annually within the next 5 years. Recent clinical trials have established superior clinical efficacy and safety with the ICD in these conditions as compared to currently available type 1 or type 3 antiarrhythmic drugs. Ventricular tachyarrhythmias are common in the elderly and most ICD centers have elderly patients. However, very limited clinical literature exists examining the specific considerations in implementing this therapy in the elderly patient and clinical expectations in this population.

Journal Article↗