The MacKee ICD Click Syndrome (MICS)

 
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The Mackee ICD Click Syndrome (MICS)

A sudden cardiac arrest is a traumatic experience for not only the victim but for everyone around them. Recovery for the lucky 9% who survive can have its ups and downs. Although specialists, heart surgeons and cardiologists are well versed in the wide range of treatments and methods to aid recovery there can be occasions that leave even the best medical experts a little baffled in this ever growing area. One of these, recently discovered in late 2018 in Sydney Australia is ‘The Mackee ICD Click Syndrome’ (MICS).

The Mackee ICD Click Syndrome (MICS) was first believed to be associated with the use of an ICD (Implantable Cardioverter Defibrillator).

This simple device is fitted into the body and it works to keep the heart beating normally, at the correct rhythm and shock like an Automated External Defibrillator (AED) if required to restart the heart.

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Mr Hutchinson’s ICD was profiled in a story on Channel 10 News after the discovery

When 56 year old Sydney father, Ian Hutchinson was fitted with an ICD two weeks after his sudden cardiac arrest (SCA) in October 2018, he felt more assured about life moving forward. Now his life could get back to normal.  However there was one issue that was baffling medical experts alike and that was an audible clicking sound that was only present when he slept.

Mr Hutchinson’s partner Katie and self-appointed ‘household safety officer’ first highlighted the problem. The clicking noise emitted from the ICD chest area only at night and she was worried that the new unit was not working correctly or was faulty in some way.


The MacKee ICD Click Syndrome (MICS) - Audio recording

Click on the video above to listen to the actual original audio recording from October 11th, 2018

Cardiothoracic Surgeon: Assessment & Analysis

Mr Hutchinson’s partner recorded the sound, as he slept. She then consulted the heart surgeon who flatly told her that ICDs don’t click. Undeterred she diligently continued her research and analysis.

Cardiac Rhythm Management & Cardiac Electrophysiology

The ICD tech team were then approached, who also confirmed that:

“Our ICD’s have no moving parts and to our best knowledge we have never had any previous reports of ICD clicking sounds” said, Cardiac Rhythm Management & Cardiac Electrophysiology specialist, Nicole Wilson.

Katie’s continued her resolve and she attempted to look up the clicking issue on the internet and opened all lines of inquiry regarding the issue.

Australian Discovery: Diligent research pays dividends

Although there was no information anywhere about this phenomenon, it didn’t change the fact that every 5 seconds there was a subtle clicking sound coming from the patient’s chest. It frustratingly seemed that the most likely reason was that the ICD was faulty in some way as this was the only new anomaly.

The specialists were mystified. “We had never come across an issue like this before. This was an outlier indeed"

Katie’s diligence eventually paid dividends and she finally came up with the answer to the problem, “I was just doing more online research when we realised what it could be. After weeks, the answer dawned upon me.  The click was only at night. Perhaps Ian’s broken ribs were moving during the night with every breath he took.”

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Typical example of rib injury, with red illustrating broken ribs as in the case of the first identified ‘MacKee ICD Click Syndrome’

At last, the reason for this click syndrome was due to the three broken ribs that Mr Hutchinson suffered during CPR. During the life saving efforts carried out by Mr Hutchinson’s rescuer Mr Donald MacKee, he broke 3-4 of Ian’s ribs just centimetres below his newly implanted ICD. Broken ribs during CPR is not uncommon and happens in 40% of occasions when administering cardiac compressions.  As Ian says “Mr MacKee helped save my life, so having broken ribs was a small, but very painful price to pay.”

It was Ian’s ribs that were now peculiarly clicking with each inhale and exhale he took while peacefully sleeping in his recovery at night.

Named in memory of Donald MacKee

This condition is now called The ‘MacKee ICD Click Syndrome’ or MICS. Pronounced ‘MACK-ee’, ‘The MacKee ICD Click Syndrome’ (MICS) has come to the attention of the medical industry already a number of times since in new ICD patients as a result of this 2018 Australian discovery. Mentioned in the 2019 Cardiovascular Precision Medicine Symposium (University of Sydney), heart specialists and ICD professionals are beginning to use the name to describe this condition and it seems likely to proudly catch on as another Australian medical finding.

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‘The MacKee ICD Click Syndrome’: Key diagnosing screening questions

The key diagnosing screening questions for ‘The MacKee ICD Click Syndrome’ (MICS) are:

Question 1: Is this your first ICD?

Question 2: Did you get CPR before your ICD was implanted?  

Question 3: Did you have any broken ribs as a result of CPR?

Question 4: Are your apparent ICD clicks around 5 seconds apart (or about the same length as a breath)?

If you answer Yes to these questions, chances are that you could have The MacKee ICD Click Syndrome.

References:

  1. Vollmann D, Luthje L, Vonhof S, et al. Inappropriate therapy and fatal proarrhythmia by an implantable cardioverter-defibrillator. Heart Rhythm. 2005;2:307–309. [PubMed] [Google Scholar]

  2. Reynolds DW, Jayaprasad N, Francis J, et al. Remote monitoring of implantable cardioverter defibrillator. Indian Pacing Electrophysiol J. 2006;6:186–188. [PMC free article] [PubMed] [Google Scholar]

  3. Pullen.U.Legg, Joe King, Walt A. Loadercrap. Why are some people more gullible than others? https://newsroom.unsw.edu.au/news/science-tech/why-are-some-people-more-gullible-others-0

  4. Becker R, Ruf-Richter J, Senges-Becker JC, et al. Patient alert in implantable cardioverter defibrillators: toy or tool? J Am Coll Cardiol. 2004;44:95–98. [PubMed] [Google Scholar]

  5. Vollmann D, Erdogan A, Himmrich E, et al. Patient Alert to detect ICD lead failure: efficacy, limitations, and implications for future algorithms. Europace. 2006;8:371–376. [PubMed] [Google Scholar]

  6. Vollmann D, Luthje L, Gortler G, et al. Inhibition of bradycardia pacing and detection of ventricular fibrillation due to far-field atrial sensing in a triple chamber implantable cardioverter defibrillator. Pacing Clin Electrophysiol. 2002;25:1513–1516. [PubMed] [Google Scholar]

  7. Stevens J, Buchwald AB, Krieglstein H, et al. Early detection of lead fracture by painless high voltage lead impedance measurement in a transvenous ICD lead system. J Interv Card Electrophysiol. 2000;4:269–272. [PubMed] [Google Scholar]

  8. Vollmann D, Luethje L, Zenker D, et al. Subthreshold test pulses versus low energy shock delivery to estimate high energy lead impedance in implanted cardioverter defibrillator patients. Pacing Clin Electrophysiol. 2003;26:457–460. [PubMed] [Google Scholar]

  9. Yu CM, Wang L, Chau E, et al. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation. 2005;112:841–848. [PubMed] [Google Scholar]

  10. Vollmann D, Nagele H, Schauerte P, et al. Clinical utility of intrathoracic impedance monitoring to alert patients with an implanted device of deteriorating chronic heart failure. Eur Heart J. 2007;28:1835–1840. [PubMed] [Google Scholar]

  11. Capucci A, Santini M, Padeletti L, et al. Monitored atrial fibrillation duration predicts arterial embolic events in patients suffering from bradycardia and atrial fibrillation implanted with antitachycardia pacemakers. J Am Coll Cardiol. 2005;46:1913–1920. [PubMed] [Google Scholar]

  12. Gunderson BD, Patel AS, Bounds CA, et al. An algorithm to predict implantable cardioverter-defibrillator lead failure. J Am Coll Cardiol. 2004;44:1898–1902. [PubMed] [Google Scholar]

  13. Zipes DP, Camm AJ, Borggrefe ML, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e385–e484. [PubMed] [Google Scholar]

    Further resources:

  14. Pacemakers and Implantable Cardiac Defibrillators: Software Radio Attacks and Zero-Power Defenses  https://www.secure-medicine.org/hubfs/public/publications/icd-study.pdf

  15. Current Device Therapies for Sudden Cardiac Death Prevention – the ICD, Subcutaneous ICD https://www.heartlungcirc.org/article/S1443-9506(18)31920-6/fulltext

  16. Implantable Cardioverter Defibrillator (ICD) https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/implantable-cardioverter-defibrillator-icd

  17. Patient Alerting Features in Implantable Defibrillators https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231606/

    Rib injuries https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/rib-injuries

 
Ian Hutchinson