Ahsen KAYA, Cemil ÇELİK, Hülya GÜLER, Ender ŞENOL, Ekin Özgür AKTAŞ

Aile İçi Şiddet Sonrası İmplante Cardioverter Defibrillator (ICD) Lead Fraktürü Meydana Gelen Olgunun Medikolegal Değerlendirmesi

Son yıllarda ani kardiyak ölüm oranlarında artış görülmektedir. Günümüzde, implante edilebilir kardiyoverter defibrilatör (implantable cardioverter defibrilator, ICD) ani kardiyak ölümleri önlemede kullanılan bir cihazdır. Travma sonucunda cihazda birtakım problemler meydana gelebilmektedir. Kablo kırığı bu problemlerden biridir. Literatürde, künt travmaya bağlı ICD komplikasyonlarının, özellikle kablo kırığının oldukça nadir görüldüğü belirtilmektedir. Bu olgu sunumunda; eski eşi tarafından sol kolu çekilerek künt travmaya maruz kalan ve oluşan kablo kırığı nedeniyle uygunsuz şoklara maruz kalan kadın olgu medikolegal açıdan değerlendirildi. Olguda, göğse direkt bir travma olmadan, sol kolun çekilmesine bağlı olarak lead kırığı meydana gelmiştir. Hafif şiddetteki bir travmanın bile, yaşamsal tehlike oluşturabilecek, ciddi klinik sonuçlara neden olabileceğine dikkat çekmek amaçlandı.

Anahtar Kelimeler:

partner şiddeti, künt travma, ani ölüm, adli tıbbi değerlendirme, Implante edilebilir kardiyoverter defibrilatör

Medicolegal Evaluation of the Case of Implantable Cardioverter Defibrillator (ICD) Lead Fracture Due to Domestic Violence

There has been an increase in sudden cardiac death in recent years. Lately, implantable cardioverter defibrillator (ICD) is a device which is used to prevent sudden cardiac death. Some problems may occur in the device as a result of trauma. Lead fracture constitutes one of these problems. In the literature, blunt trauma-related ICD complications, particularly lead fracture, seem to be very rare. In this case report, we evaluated a female patient who was exposed to a blunt trauma while getting pulled her left arm by her ex-husband and to some inappropriate shocks due to lead fracture, in medicolegal aspect. In case, a lead fracture occurred by pulling her left arm without chest trauma. It is aimed to take importance that even a mild violence might cause life-threating, severe clinical outcome.

Keywords:

Partner violence, blunt trauma, sudden death, medicolegal evaluation, Implantable Cardioverter Defibrillator,

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Ezekowitz JA, Rowe BH, Dryden DM, Hooton N, Vandermeer B, Spooner C, et al. Systematic review: implantable cardioverter defibrillators for adults with left ventricular systolic dysfunction. Ann Intern Med. 2007;147(4):251-62.
Alter P, Waldhans S, Plachta E, Moosdorf R, Grimm W. Complications of implantable cardioverter defibrillator therapy in 440 consecutive patients. Pacing Clin Electrophysiol. 2005;28(9):926-32.
Kron J, Herre J, Renfroe EG, Rizo-Patron C, Raitt M, Halperin B, et al. Lead- and device-related complications in the antiarrhythmics versus implantable defibrillators trial. Am Heart J. 2001;141(1):92-8.
Yaminisharif A, Soofizadeh N, Shafiee A, Kazemisaeid A, Jalali A, Vasheghani-Farahani A. Generator and lead-related complications of implantable cardioverter defibrillators. Int Cardiovasc Res J. 2014;8(2):66-70.
Jarman JWE, Lascelles K, Wong T, Markides V, Clague JR, Till J. Clinical experience of entirely subcutaneous implantable cardioverter-defibrillators in children and adults: cause for caution. Eur Heart J. 2012;33(11):1351-9.
Messali A, Thomas O, Chauvin M, Coumel P, Leenhardt A. Death due to an implantable cardioverter defibrillator. J Cardiovasc Electrophysiol. 2004;15(8):953-6.
Pinski SL, Fahy GJ. The proarrhythmic potential of implantable cardioverter-defibrillators. Circulation. 1995;92(6):1651-64.
Bőhm A, Duray G, Kiss RG. Traumatic pacemaker lead fracture. Emerg Med J. 2013;30(8):686.
Barakat AF, Cross B, Wertz J, Saba S, Kancharla K. Cardiac implantable electronic device malfunction after deceleration injury without obvious chest trauma. HeartRhythm Case Rep. 2019;5(5):285-7.
Catanchin A, Anderson L, Jones S, Ward D. When life‐saving devices terminate life. J Cardiovasc Electrophysiol. 2008;19(3):316-8.
Chen WL, Chen YJ, Tsao YT. Traumatic pacemaker lead fracture. J Trauma. 2010;69(4):E34.
Junge M, Weckmüller J, Nägele H, Püschel K. “Natural death” of a patient with a deactivated implantable-cardioverter-defibrillator (ICD)? Forensic Sci Int. 2002;125(2-3):172-7.