Traumatic Tension Pneumothorax as a Cause of ICD Failure
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Introduction
Tension pneumothorax, although usually associated with pulseless electrical activity, can infrequently cause serious ventricular arrhythmias. Moreover, it has been reported to increase the threshold of internal and external defibrillation of such arrhythmias. Pneumothorax should be suspected whenever there is failure or difficulty in internal or external defibrillation of ventricular arrhythmias. We report a case of ventricular tachycardia following the development of traumatic tension pneumothorax and review the pertinent literature.

Case Report
A 65-year-old African-American female was brought in to our emergency department by ambulance complaining of dyspnea after being forced down by cops during the arrest of her son. She had history of mitral valve replacement for severe mitral regurgitation. She also had a left-sided biventricular implantable cardioverter defibrillator (ICD) inserted for symptomatic severe nonischemic cardiomyopathy with left bundle branch block, which replaced a right-sided dual chamber pacemaker previously implanted for intermittent complete heart block. Shortly after arrival, she developed a brief episode of pulseless electrical activity followed by sustained ventricular tachycardia, which gradually accelerated, causing repetitive unsuccessful ICD shocks....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220567/
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