Case Report
The patient is a 43-year-old male with non-ischemic cardiomyopathy, left
ventricular ejection fraction of 15%, and paroxysmal atrial
fibrillation who had an ICD implanted (Biotronik Intica 7 VRT DX). The
patient presented with decompensated heart failure complicated by
cardiogenic shock approximately 6 weeks post-implant. The patient was
managed with inotropic therapy, an intra-aortic balloon pump, and
evaluated for advanced therapies. A HeartMate III LVAD was placed as a
bridge to transplant. Eleven months later, remote ICD monitoring
reported persistent atrial fibrillation with periods of rapid
ventricular rates resulting in inappropriate anti-tachycardia pacing and
ICD shocks. With shared decision-making, it was decided to deactivate
the tachyarrhythmia therapies. However, in-office interrogation of the
ICD was unsuccessful. A pseudo-Faraday cage created by a cast-iron pan
was placed on top of the ICD and failed. Successful interrogation and
reprogramming were only achieved when the patient was instructed to
extend his arm (on the ipsilateral side of the ICD) above his head, thus
increasing the distance between LVAD and ICD from 4 cm (Fig 1) to over
10 cm, eliminating the interaction.