Implantable defibrillator explosion following gunshot: when the defibrillator not only prevents arrhythmic death

A 70-year-old man presented to the emergency department with accidental gunshot wound at left hemithorax and left shoulder/arm. Initial clinical assessment showed stable vital signs and an implantable cardioverter-defibrillator (ICD) protruding outside from large wound in the infraclavicular region. The ICD, previously implanted for secondary prevention of ventricular tachycardia, appeared burned and the battery was exploded. Urgent chest computed tomography scan was performed with evidence of left humeral fracture without significant arterial injury. The ICD generator was disconnected from passive fixation leads and removed. The patient was stabilized and the humeral fracture was fixed. Then lead extraction was successfully performed in a hybrid operating room with cardiac surgery standby. The patient was discharged in good clinical conditions after reimplantation of a novel ICD in the right infraclavicular region. Emerging technologies are promising in making lead extraction safer and more accessible for patients worldwide. This case report provides the most up-to-date indications and procedural approaches for lead extraction and insights on the future trends in this field.

Automated summary

A 70-year-old man presented with accidental gunshot wound in the left hemithorax and left shoulder/arm. The implantable cardioverter-defibrillator (ICD) previously implanted for ventricular tachycardia was burned and the battery exploded. Urgent chest CT scan showed left humeral fracture without significant arterial injury. ICD generator was removed, humeral fracture was fixed, and lead extraction was successfully performed.