Intentional Electric Fence Defibrillation: A Novel Approach in the Bush

Dr. Thomas Williams, Professor Joseph Suttie

Aim:

We present the case of a 77-year-old tradesman with an implantable cardiac device (ICD) who self-cardioverted himself by touching an electrical fence.

Case Background:

An ICD was inserted in 2004 for primary prevention secondary to dilated cardiomyopathy, with a battery a change in 2012. Comorbidities include atrial fibrillation, gastroesophageal reflux disease, obstructive sleep apnoea. A transthoracic echocardiogram showed an ejection fraction of 30-35%. The patient had ongoing symptomatic episodes of atrial fibrillation which proved difficult to control. He was initially against betablockade, resulting in him returning to hospital on multiple occasions for transoesophageal cardioversion. Due to his proximity of the hospital he began to decline cardioversions and resulted in him turning to non-pharmacological reversion strategies. Valsalva manoeuvres were ineffective. The patient then finally turned to self-induced electrical cardioversion, whereby he deliberately interacted with an electric animal fence which then subsequently resulted in a shock from his implantable cardiac device, reverting him to sinus rhythm.

Results:

The serial impedance was measured pre and post the cardioversion and was preserved throughout (Table 1; Graph 1). The over al function of the device was not also affected as it was able to appropriate sense and deliver a 35J shock due to non-sustained ventricular tachycardia. Examination of the defibrillator revealed normal skin and normal lead location.

Conclusion:

Inducing electrical cardioversion from an implanted cardiac device for atrial fibrillation can be effective in reverting to sinus rhythm without having any long-term effects on impedance however the behaviour is not endorsed.