DC Cardioversion

DOI: 10.19102/icrm.2012.030904

RENEE M. SULLIVAN, MD and BRIAN OLSHANSKY, MD, FHRS

The authors report no conflicts of interest for the published content.
Manuscript submitted June 27, 2012, final version accepted July 3, 2012.
Address correspondence to: Brian Olshansky, MD, Professor of Medicine, Cardiac Electrophysiology, University of Iowa Hospitals, 200 Hawkins Drive, Room 4426a JCP, Iowa City, IA 52242. E-mail: brian-olshansky@uiowa.edu

Case study

A 54-year-old man with ischemic cardiomyopathy and atrial fibrillation refractory to external biphasic cardioversion attempts presented for biventricular implantable cardioverter-defibrillator (ICD) interrogation. His fatigue and dyspnea had improved since a Doctor of Chiropractic (DC) treated his back pain 2 months earlier with transcutaneous electrical nerve stimulation (TENS), resulting in a painful shock to the chest. Interrogation showed “refractory” atrial fibrillation converted to sinus rhythm with an ICD shock due to electromagnetic interference from the TENS unit. Failed external cardioversion does not preclude success of another attempt; sinus rhythm may be maintained. Although the outcome was propitious, clinicians must be vigilant lest a TENS unit precipitate a serendipitous, yet inappropriate, ICD shock causing stroke or death in inadequately anticoagulated patients, not to mention a kick in the chest.