Skin injury following prolonged fluoroscopy: early and late appearances

Abstract

In October 2005, a 45-year-old woman presented to our centre for evaluation of recurrence of palpitations following a cardiac electrophysiology study performed 7 weeks previously at another centre. The patient had a long history of a hypercoagulable disorder (anti-phospholipid syndrome). At age 40, she had suffered an extensive inferolateral wall myocardial infarction. Coronary angiography demonstrated an occluded large marginal branch of the circumflex artery. This was treated by balloon angioplasty and stent placement. Unfortunately, despite optimal medical therapy, the patient developed progressive left ventricular systolic dysfunction. Indeed, by 4 years after her myocardial infarction, her left ventricular ejection fraction had fallen to 25%. Given the considerable potential for the development of malignant ventricular cardiac dysrhythmias associated with such depressed cardiac function,1 she then underwent prophylactic placement of an implantable cardioverter-defibrillator (ICD) device. She also underwent repeat coronary angiography at this time. This showed continuing patency of the previously placed stent and no other significant stenosis. One year later, the patient experienced multiple ICD shocks. Analysis of the device revealed that the ICD discharges had been caused by episodes of supraventricular tachycardia that had been mistakenly interpreted by the device as episodes of ventricular tachycardia. To address the problem of these inappropriate ICD discharges, the patient underwent a cardiac …