Patient Dies After Being Sent Home With Dysfunctional Pacemaker

This pacing systems case involves a fifty-eight-year-old female patient after receiving a pacemaker in 2011. The patient presented to her doctor with complaints of shortness of breath, weakness, and fatigue. During the visit, the patient had a pulse of 38 and an EKG that showed AV block with sinus bradycardia. Furthermore, the patient had a chest X-ray that showed displacement of the ventricular and atrial leads. The patient’s doctor chose not to admit her and sent her home. He also scheduled her for a procedure to reposition the pacemaker leads at another institution. The doctor ensured the patient that she had no real risk, but she went home and was found dead two hours later.

Question(s) For Expert Witness

1. Should this patient have been admitted to the hospital or could this medical scenario have been followed up in the outpatient setting?

Expert Witness Response E-001200

I would potentially admit this patient to the hospital based on a few factors. It would depend on what type of "escape" rhythm the patient had i.e. where the level of AV block was localized. I would be wary to just send this patient home without knowing what the underlying cause of the AV block was. It would also depend on the severity of the symptoms, particularly if the patient had syncope. Additionally, I would evaluate the chest X-ray in more detail given that the ventricular lead was displaced, which can lead to a fatal arrhythmia.