About the Cover
ON THE COVER A 65-year-old male patient with coronary artery disease, bypass surgery, and congestive heart failure with a left ventricular ejection fraction of 15% underwent an atriobiventricular defibrillator implant. He improved significantly after the device implant and was in functional class I. Two months after the implant, he received 2 defibrillator shocks while straining in the bathroom. The device interrogation revealed "noise" with no arrhythmias. The ventricular screw-in electrode showed a small R-wave of <0.5 mV and no ventricular capture. A chest X-ray showed the right ventricular electrode deep in the right ventricular apex. An echocardiogram showed no pericardial effusion and did not clearly demonstrate perforation by the defibrillator electrode. A 64-slice CT study was obtained. The CT picture demonstrates the double-coil defibrillator electrode protruding the right ventricular apex. The patient was asymptomatic and hemodynamically stable. He was taken to the operating room and the right ventricular electrode was removed under transesophageal echo guidance. There was no accumulation of blood in the pericardium. A new screw-in electrode was placed in the right ventricular outflow tract. The patient recovered and was doing well at his 4 months follow-up visit. Images provided by Therese Fuchs, MD, Alon Stamler, MD, from the Arrhythmia Service, Assaf Harofeh Medical Center, Zrifin, Sackler School of Medicine, and Rabin Medical Center, Petah-Tikva, Israel
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Copyright © 2008 by the American College of Cardiology Foundation.
