title: A case of inefficient defibrillation during thoracotomy.
abstract: We describe the case of an accidental intraoperative ventricular fibrillation that could not be interrupted by a 35-J shock fired by an implantable cardioverter defibrillator (ICD). We believe that the iatrogenic pneumothorax induced by thoracotomy during the epicardial lead implant temporarily changed the intrathoracic impedance, causing an increase in defibrillation threshold. This possible change in impedance with resulting ineffective interruption of arrhythmia should be taken in consideration when a thoracotomy is planned in a patient bearing an ICD.
authors.affiliation: Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy. sandro.sponga@unipd.it
authors.forename: Sandro
authors.initials: S
authors.lastname: Sponga
authors.forename: Giosuè
authors.initials: G
authors.lastname: Mascioli
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.forename: Ettore
authors.initials: E
authors.lastname: Vitali
mesh_terms: D017147:Defibrillators, Implantable; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D007431:Intraoperative Complications; D008875:Middle Aged; D013908:Thoracotomy / Q000379:methods*; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy