Abstract

We report a case of an unusual complication of bilateral humeral head fractures caused by repeated ICD shocks secondary to torsade de pointes electrical storm. A 59-year-old female with osteoporosis and ICD treated with Sotalol for atrial fibrillation presented after receiving multiple ICD shocks due to recurrent torsade de pointes in the setting of severe hypokalemia. The patient complained of severe bilateral shoulder pain. Shoulder X-rays showed osteopenia with bilateral comminuted humeral head fractures. Bilateral shoulder CT scans showed no findings to suggest pathologic fractures. She had no direct shoulder trauma. The comminuted proximal humerus fractures were not amenable to surgical intervention. Sotalol was stopped, electrolytes were corrected with no recurrence of ICD shocks over the next five years of clinical follow-up. This case highlights the need to take the necessary steps to reduce the risk of ICD shocks in patients with osteoporosis to minimize fragility fractures. Catheter ablation, optimizing ICD detection zones and therapies, and antiarrhythmic medications are useful means to reduce ventricular arrhythmia burden and ICD shocks. Mechanical ventilation and the use of paralytic agents could also be considered early during electrical storm treatment when dealing with at-risk patients.