Pacemaker Battery Replacement Causes Cardiac Arrest

This case involves a 61-year-old female with a past medical history of HTN, CAD, CHF, Afib with a status post biventricular ICD implant. The patient underwent a procedure to correct and replace an AICD battery due to pacemaker fuel-cell generator depletion. During the procedure, the patient experienced cardiac and respiratory distress that went unnoticed for a significant time period. When physicians finally uncovered that the patient was unresponsive, CPR was initiated and the patient was transferred to the ICU. The patient suffered from anoxic brain injury and died 3 weeks after the procedure.

Question(s) For Expert Witness

1. Is this a known complication of this procedure and if so how often does it happen?

Expert Witness Response E-004780

It is difficult to understand how a cardio-respiratory arrest would go unnoticed in a properly monitored patient during an ICD replacement. At all times patients undergoing this procedure will be monitored closely from a cardiac perspective and any deviation from a normal heart rhythm should be addressed immediately. Adverse cardiac events may happen during any heart procedure no matter how minor, but this case seems like a few ominous signs went unnoticed for this patient to decompensate so quickly.