This case involves a middle-aged female patient with a history of chronic heart failure who presented to the hospital to have an implantable cardioverter defibrillator (CRT device) placed. During the surgery, the device placement was complicated by a wire that became disconnected from the insertion tube. After the operation, the patient began having extreme chest pain that worsened with breathing. She was treated with morphine but felt no relief. A chest x-ray revealed the patient had a widened mediastinum. Cardiothoracic surgery was consulted and the patient was taken for sternotomy. During surgery, the patient was found to have a wire in her heart membrane that had perforated into the pleural space and caused a collection of blood between her chest wall and lung.
Question(s) For Expert Witness
- 1. Please describe your background in cardiology.
- 2. How routinely do you treat patients like the one described above?
- 3. Have you ever published or lectured on this subject / issue?
Expert Witness Response E-063122
I’m a board-certified cardiac electrophysiologist and I implant CRT devices on a regular basis — roughly 50 per year for the past 12 years. I lecture to cardiology fellows, residents, and medical students on the topic of CRT and device implantation. I have never seen an acute lead fracture or broken wire during a CRT case, as described in the case above. I have seen cardiac perforation and pericardial effusion during a pacemaker and/or ICD implant, but not related to a fractured or broken off piece of the device / lead hardware. That is quite unusual. I implant these devices regularly and I understand the indications for device implantation. I am aware of the known complications of device implantation and am familiar with managing complications due to device implantation. I have performed medical records review for cases in the past. Regarding this case, there are many other details that require review in order to fully understand the complication and how it was handled.