Bullet Impact Into Automatic Implantable Cardioverter-Defibrillator Averts Serious Injury and Death

A 26-year-old man with hypertrophic obstructive cardiomyopathy and an automatic implantable cardioverter-defibrillator (AICD) sustained a gunshot injury to the left side of his chest wall, resulting in direct impact bullet into AICD generator. The resulted dent outer case along damage generator battery device deactivation. There was no associated intrathoracic injury. successfully replaced, patient discharged. This report describes comprehensive analysis management this extraordinary young lifelong need for AICD. Rarely has it been described that altered trajectory bullet, saving patient’s life unusual unintended manner.1Perahia T. Kleinman D.S. Habre W.G. Your automated cardioverter defibrillator is not bulletproof vest but might save your life.Clin Pract Cases Emerg Med. 2019; 3: 191-193Crossref Google Scholar,2Sheppard R.C. Levine J.C. Rovin J. van Gelder H.M. novel way prevents death: protection from gunshot.Heart Rhythm. 2009; 6: 1390Abstract Full Text PDF PubMed Scholar Although effect on function remains unpredictable, detailed interrogation radiographic shed some light integrity system. walked urban community hospital multiple wounds, including 1 posterolateral thoracoabdominal region. He had history sudden cardiac death 3 years earlier, after which he received subcutaneous (S-ICD). Chest radiographs demonstrated retained struck (Figure 1A; Supplemental Figures 1, 2) showed other cardiopulmonary After transfer our facility, computed tomography abdomen missile deep generator, exhibited irregular contours, without violation pleural or peritoneal cavities 1B). prescribed cefazolin as prophylaxis because open wounds. magnet placed over subcutaneously S-ICD prevent possible inappropriate therapy. next day, taken operating room replacement device. interrogated programmer. It able be turned off; however, impedance could calculated. noted deformed punctured. lead uninvolved signs damage. fragments were identified removed assistance fluoroscopy (Figures 1C, 2; 2, 3). wound excised closed. Given age ICD, new adjacent submuscular pocket. Cefazolin continued 48 hours, discharged home second postoperative day. Outpatient follow-up through 5 months evidence infection.Figure 2Automatic intact lead, fragment explantation (scale bar = 15 mm).View Large Image Figure ViewerDownload Hi-res image Download (PPT) extracted returned manufacturer (Boston Scientific) analyzed. Interrogation revealed system errors. Visual inspection confirmed cracking any indication device’s hermetic seal compromised. X-rays also 3A, 3B ); charging circuitry extensive 3C). damaged would have prevented well conducting measurements. Gunshot wounds involving are extremely rare. represents only third literature first involve Two existing reports literature,1Perahia both transvenous ICDs, survival generators replaced at same site. devices did fire inappropriately either 2 reported cases found inactive analysis. Management these unique injuries requires careful consideration risk due malfunctioning device, infection when replacing leaking material potential emergent traumatic injuries. Fortunately, life-threatening leak lithium manganese dioxide battery. age, we opted preserve rather than place case, significant dent, manufacturer’s engineers compromise perimeter weld case. internal components (including circuitry) exposed external environment. metal cell (located near point impact) bent remained intact. indications electrolyte release within interior Leakage rare may until removal Whereas does specific recommendations treatment if there leakage material, recommend urgent (within 24-48 hours) all obvious batteries. If leakage, copious irrigation remote site Of note, form hydrogen gas hydrofluoric acid mixed water. In minutes caution use electrocautery flammable gases dissipated recommended.3Primary cylindrical cellSafety data sheet MSDS 2.001.008. VARTA Microbattery GmbH, 2020https://sid.siemens.com/api/khub/documents/5y7dlu0oJ6HspKrJX8XHZw/contentDate accessed: December 22, 2022Google concern infectious contamination pocket, temporary followed by permanent course antibiotics desirable option. circuit impact, preventing obtaining Per design, EMBLEM conducts measurements high-voltage capacitors level then delivering small charge across electrode. Because location damage, unable perform required obtain displayed corresponding alerts programmer screen before explantation. summary, demonstrates adult patient. Important considerations managing such patients include hermetically sealed inability properly sense deliver shock therapy impact. Optimal should coordinated between different medical specialists ensure timely concomitant can viewed online version article [10.1016/j.atssr.2023.01.002] http://www.annalsthoracicsurgery.org. authors wish acknowledge diligent provided Rhythm Division Boston Scientific comments Ms Stephanie R. Wallace, MS, principal quality assurance engineer Scientific, St Paul, Minnesota.