Cardiac rhythm recorded by implanted loop recorder during lightning strike

Lightning-induced pacing system malfunction: a case report

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.

Lightning and the Forensic Pathologist

This paper explores the pathology caused by lightning. It covers the basic physics and mechanisms of injury of lightning strikes followed by a short discussion. The purpose of this paper is to suggest an approach to the investigation and autopsy of a lightning-related death.