A cardiology expert witness advises on a pacing systems case involving a man, located in South Dakota, who underwent biventricular ICD placement with AV node ablation. The cardiologist positioned three leads in his heart: one to the right ventricle (RV), one to the left ventricle (LV), and one to the right atrium.
During a check of the pacemaker in the cardiologist’s office, the technician noted he was unable to capture the RV lead. The right ventricular lead’s sensing on this date was 2.3 millivolts. Since the RV lead was not capturing, the cardiologist performed a lead revision, in which the right ventricular and atrial leads were disconnected and repositioned.
Several months later, the right ventricular lead’s sensing was 2.8 millivolts, which was a significant decrease from the most recent prior reading of 11.5 millivolts about a month before.
Plaintiffs allege that the cardiologist was, or should have been, aware of the 2.8 millivolts reading and he did nothing to investigate the cause of the low value. Two months later, the decedent went into cardiac arrest. An x-ray confirmed that the right ventricular lead was dislodged and had retracted to the right atrium.
Question(s) For Expert Witness
- 1. Did the cardiologist violate the standard of care?
- 2. What should the cardiologist have done?
Expert Witness Response
Based on my review of the medical records, my background, training, experience, education, and expertise, and my knowledge of the standard of care required by cardiac electrophysiologists such as the defendant, it is my opinion that he deviated from the accepted standard of care and was negligent in at least the following ways:
• Failing, after right ventricular sensing was noted to be 2.8 millivolts, to order a chest x-ray to see if the RV lead was dislodged;
• Failing, after right ventricular sensing was noted to be 2.8 millivolts, to order defibrillator threshold testing (DFT);
• Failing to take any action to investigate the significant decrease in sensing of the right ventricular lead when it was noted to be 2.8 millivolts, as compared to 11.5 millivolts on the previous test; and
• Failing to recognize that decedent’s ICD was not functioning properly.
It is my opinion to a reasonable degree of medical certainty that if the appropriate standard of care had been followed, had the defendant investigated the alarmingly low right ventricular sensing value and learned the RV lead was dislodged, and then made an appropriate RV lead revision, then the decedent most likely would not have experienced cardiac arrest.
It is my opinion to a reasonable degree of medical certainty that the deviations from the applicable standard of care outlined above proximately caused injuries to, and the death of, the decedent.
The expert is a medical doctor, specializing in cardiology and electrophysiology.