Cardiology Expert Witness Advises on Faulty Pacemaker That Caused Man’s Death

ByKristin Casler

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Updated onOctober 3, 2017

Cardiology Expert Witness Advises on Faulty Pacemaker That Caused Man’s Death

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.

The decedent suffered respiratory failure leading to an anoxic brain injury and sepsis before he died two months later.

Question(s) For Expert Witness

1. Did the cardiologist violate the standard of care?

2. What should the cardiologist have done?

Expert Witness Response

inline imageBased 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:

inline image• 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;

inline image• Failing, after right ventricular sensing was noted to be 2.8 millivolts, to order defibrillator threshold testing (DFT);

inline image• 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

inline image• Failing to recognize that decedent’s ICD was not functioning properly.

inline imageIt 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.

inline imageIt 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.

inline imageThe expert is a medical doctor, specializing in cardiology and electrophysiology.

About the author

Kristin Casler

Kristin Casler

Kristin Casler is a seasoned legal writer and journalist with an extensive background in litigation news coverage. For 17 years, she served as the editor for LexisNexis Mealey’s litigation news monitor, a role that positioned her at the forefront of reporting on pivotal legal developments. Her expertise includes covering cases related to the Supreme Court's expert admissibility ruling in Daubert v. Merrell Dow Pharmaceuticals Inc., a critical area in both civil and criminal litigation concerning the challenges of 'junk science' testimony.

Kristin's work primarily involves reporting on a diverse range of legal subjects, with particular emphasis on cases in asbestos litigation, insurance, personal injury, antitrust, mortgage lending, and testimony issues in conviction cases. Her contributions as a journalist have been instrumental in providing in-depth, informed analysis on the evolving landscape of these complex legal areas. Her ability to dissect and communicate intricate legal proceedings and rulings makes her a valuable resource in the legal journalism field.

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