Sudden death of a patient with a pacemaker caused by heart rupture in a "cloisonné" pericardium
Maendely, R.; Aldakar, M.; d'Hautefeuille, B.; Fontaine, G.; Linares-Cruz, E.; Frank, R.; Tonet, J.L.; Grosgogeat, Y.
Annales de Cardiologie et d'Angeiologie 36(7): 355-359
1987
ISSN/ISBN: 0003-3928 PMID: 3662383 Document Number: 303767
Myocardial infarction is sometimes accompanied by bradycardia requiring either temporary or permanent cardiac pacing. In addition an MI reduces the amplitude of endocardial action potentials which produces the conditions for defective detection of spontaneous ventricular complexes by the pacemaker. In this particular condition, the competing cardiac rhythm which arises frequently causes malignant arrhythmias which are potentially fatal. This danger is increased even further by endocardial stimulation of the right ventricle with myocardial infarction of the right ventricle. We have reported in this paper the instructive case of a patient with coronary heart disease, hospitalized for third degree AV block with syncope which developed following a massive postero-diaphragmatic MI, but with few symptoms. After secondary extension of the necrotic area, the artificial pacemaker implanted manifested defective firing which resulted in development of ventricular fibrillation. The latter was controlled by cardioversion, but the patient died from disordered conduction after 30 seconds of complete asystole. For one minute, the pacemaker did not stimulate the ventricle because of "electrical stunt to the myocardium", caused by the shock from the defibrillator. Anatomical examination (at autopsy) confirmed the cardiac rupture.