An Uncommon Intraoperative Implantable Cardiac Device Complication and Subsequent Troubleshooting

483 reconstruction with local tissue transfer. Intraoperatively, the surgeon noticed that the tumor was involving the pectoralis major muscle superiorly and was growing into the anterior and lateral pocket of the previous ICD generator location. This resection was undertaken carefully with the harmonic scalpel. One of the wires was intimately attached to the posterior aspect of the tumor embedded within the peritumoral fibrosis and was more posterior and lateral in location. Unknown to the surgeon, the LV wire’s insulation was damaged by the harmonic scalpel. The anesthesiologist immediately noticed a loss of the lead capture on the electrocardiogram with the patient having subsequent symptomatic bradycardia down to 40 beats/min. This acute change was immediately communicated to the surgeon. Emergent intraoperative cardiology consultation was obtained. ICD function was checked and determined that the LV wire was still functional. Silicone adhesive (Silastic® Medical Adhesive) was applied per Medtronic protocol over the damaged wire insulation to protect it. After the placement of the silicone adhesive, the ICD immediately started to recapture. The remainder of the surgical dissection was completed without further events, and the patient remained hemodynamically stable.