Implantable cardioverter defibrillator and paradoxical cerebral embolism

pp. 222-224

Abstract

Implantable cardioverter-defibrillators (ICD) are effective in preventing sudden cardiac death in patients with life-threatening ventricular tachyarrhythmias. However, severe early and late complications have been reported, such as catheter fracture and dislodgement, inappropiate ICD discharges, infection, bleeding or pocket haematoma and pneuomothorax. Cerebrovascular embolic events have rarely been reported. The objective of this paper is to present the case of a patient with an ICD and patent foramen ovalis, who suffered four transtient ischemic attacks. Transesophageal echocardiography showed the presence of thrombi on the intracardiac catheter, and right to left shunting, was demonstrated during a Valsava manouver suggesting paradoxical embolism as the possible mechanisms.