Body Piercing with a Metallic Tongue Stud Resulting in Ineffective Implantable Cardioverter-defibrillator Shocks: “Heart to Mouth”

Left ventricular assist devices (LVADs) provide circulatory support to patients with severe left ventricular systolic dysfunction. Many such patients have a pre-existing implantable cardioverter-defibrillator (ICD) at the time of their LVAD surgery. LVAD implantation can alter the ICD lead parameters, including R-wave sensing, right ventricular capture threshold, and impedance. These changes can in turn affect the ability of the ICD to successfully treat malignant ventricular arrhythmias. In most patients who present with ineffective ICD shocks, the failed shock is assumed to be secondary to the patient’s severe cardiomyopathy. Especially, the role of physical examination in such patients is often minimized. In our patient, a thorough history-taking and history-guided physical examination led us to the root cause of the failed ICD shocks. Our patient was noted to have a metal tongue piercing, which was the likely cause of his ineffective ICD shocks. Our case highlights the importance of a comprehensive history-taking and physical examination.