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. 2019 Jun 1;3(2):ytz092.
doi: 10.1093/ehjcr/ytz092.

Lightning-induced pacing system malfunction: a case report

Bogdan Obszański  1 , Łukasz Tułecki  2 , Andrzej Kutarski  3 , Andrzej Kleinrok  4
Affiliations

Lightning-induced pacing system malfunction: a case report

Bogdan Obszański et al. Eur Heart J Case Rep. .

Abstract

Background: Atmospheric electrical discharge is an extremely powerful natural phenomenon which can have dangerous and lethal effects on the human body. However, there is no evidence to indicate whether and, if so, to what extent the electric current travelling through the body can affect proper pacemaker function.

Case summary: An 80-year-old patient admitted to emergency department after being struck by a lightning bolt while riding a bike. The patient had a DDD pacemaker implanted 4 years prior to the incident. The ECG on admission depicted pacemaker spikes and native sinus rhythm at 50-60 b.p.m. On the 3rd day after admission the patient developed recurrent pacing-induced tachycardia. Pacemaker interrogation showed high pacing thresholds (failure to pace in the atrial channel). When the patient's condition stabilized she was transferred to the tertiary hospital for transcutaneous lead extraction. The extracted pacing system was sent to Biotronik for thorough evaluation.

Discussion: Injuries due to a lightning strike are considered a rare occurrence but being struck by lightning with a pacemaker or an ICD is even less common. In the present case, the cause of cardiac arrhythmia was most probably electrical burn at the endocardial-electrode interface and a sudden elevation of the pacing threshold leading to transient pacing failure in both PM channels. To the best of our knowledge, in this case presentation we first described permanent lightning-induced pacemaker dysfunction.

Keywords: Case report; Lightning; Lightning in pacemaker carrier; Lightning-induced takotsubo cardiomyopathy; Pacemaker; Transcutaneous lead extraction.

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Figures

Figure 1
Figure 1
First- and second-degree burns were visible on a line going from the left shoulder along the entire torso to the lower right extremity.
Figure 2
Figure 2
The ECG on admission depicted pacemaker spikes and native sinus rhythm at 50–60 b.p.m. On the 3rd day after admission the patient developed recurrent pacing-induced tachycardia at the rates of 140–160 b.p.m.
Figure 3
Figure 3
The old and a new DDD pacing system (before and after replacement of the whole system).
None
See this image and copyright information in PMC

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