Duru, Firat

Saguner, Ardan M.

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circumstances will, however, require prospective evaluation inadequately powered randomized studies. New strategies toprevent the development of coronary artery disease in patientswith a psychiatric illness such as anxiety or depression may be ofspecial importance in view of the lack of evidence that psychiatricmedications such as antidepressant medications decrease cardio-vascular risk.6Thus, while the exact mechanisms linking a prior psychiatrichospitalization and a first hospitalization for NCCP to increasedcardiovascular and total mortality remain uncertain, we areindebted to Gilles et al.4 for pointing out the increased cardiovas-cular risk and the need for cardiovascular evaluation of thesepatients. The increasing evidence that both vascular disease andpsychiatric illnesses such as anxiety and depression sharecommon mechanisms suggests challenges and opportunities forboth the psychiatrist and the cardiologist to improve risk detectionand to prevent cardiovascular and total mortality in patients withpsychiatric illnesses both with and without NCCP. One might con-sider a strategy such as outlined in Figure 1 for patients hospitalizedwith a psychiatric illness such as depression if we are to preventthe development of cardiovascular disease before the patient pre-sents with chest pain and an increased risk of death. This will,however, require a further understanding of the links between psy-chiatric illness and cardiovascular disease as well as prospectiveevaluation.Conflict of interest: none declared.References1. Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR,Griffith JL, Selker HP. Missed diagnosis of acute cardiac ischemia in the emergencydepartment. N Engl J Med 2000;342:1163–1170.2. Lindsell CJ, Anantharaman V, Diercks D, Han JH, Hoekstra JW, Kirk JW, Lim S-H,Peacock WF, Tiffany B, Wilke EK, Gibler WB, Pollack CV Jr. For theEMCREG-International I8trACS Investigators. The Internet Tracking Registry ofacute coronary Syndromes(i*trACS ): a multicenter registry of patients with suspi-cion of acute coronary syndromes reported using the standardized reportingguidelines for emergency department chest pain studies. Ann Emerg Med 2006;48:666–677.3. Keefe FJ, Shelby RA, Somers TJ, Varia I, Blazing M, Waters SJ, McKee D, Silva S,She L, Blumenthal JA, O’Connor J, Knowles V, Johnson P, Bradley L. Effects ofcoping skills training and sertraline in patients with non-cardiac chest pain: a rando-mized study. Pain 2011;152:707–708.4. Gillies M, Jhund PS, MacTeague K, MacIntyre P, Allardyce J, Batty GD, MacIntyre K.Prior psychiatric hospitalization is associated with excess mortality in patients hos-pitalized with non-cardiac chest pain: a data linkage study based on the full Scottishpopulation (1991–2006). Eur Heart J 2012;33:760–767.5. Bhardwaj A, Truong QA, Peacock WF, Yeo K-T J, Storrow A, Thomas S,Curtis KM, Foote RS, Lee HK, Miller KF, Januzzi JL. A multicenter comparison ofestablished and emerging cardiac biomarkers for the diagnostic evaluation ofchest pain in the emergency department. Am Heart J 2011;162:276–282.6. Cameron OG, Ehrmann DE, Pitt B. Depression, anxiety, anger, and heart failure. In:Riba M, Wulsin L, Rubenfire M, eds. PsychoCardiology: The Interface Between Psych-iatry and Cardiology. London: John Wiley & Sons, Ltd; 2011:34–48.7. Ehrmann DE, Deldin PJ, Pitt B. Cardiovascular disease, major depressive disorder,and sleep-disordered breathing: shared pathways and co-morbidities. Int J Cardiol2011;47:1–3.CARDIOVASCULAR FLASHLIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .doi:10.1093/eurheartj/ehr296Online publish-ahead-of-print 16 August 2011Implantable cardioverter defibrillator avoids shock during electrocutionArdan M. Saguner and Firat Duru*Clinic for Cardiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland* Corresponding author. Tel: +41 44 2553565, Fax: +41 44 2554401, Email: firat.duru@usz.chA 30-year-old electrician with an implantable cardioverter defibrillator(ICD) who had previous history of idiopathic ventricular fibrillation pre-sented to emergency room after incurring electrocution injury while ac-cidentally grasping a 230 Volt 50 Hz alternating current power line atwork. He was in contact with the power line for approximately 3 sthough he remained conscious. At presentation, the patient was clinic-ally in stable condition. Physical examination revealed two grade IIa en-trance burns of the right palm (Panel A, bold arrows) and one grade Iexit burn of the left palm (Panel A, thin arrow), which served as theground. The burns were surgically treated by cautious debridement.Subsequently, ICD interrogation revealed appropriate ‘noise reversion’(Panel B) due to detection of continuous high-frequency sensing in theventricular channel for 3.3 s avoiding shock delivery. No ventriculartachyarrhythmia was induced during electrocution. However, theheart rate was more rapid after the event, possibly due to sinus tachy-cardia. All ICD measurements were within the normal range. Twelve-lead surface ECG and the cardiac biomarkers remained normal afterthe event. The patient was discharged on the same day.Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2011. For permissions please email: journals.permissions@oup.comEditorial694

Implantable cardioverter defibrillator avoids shock during electrocution

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