Skip Navigation


Europace Advance Access originally published online on May 15, 2007
Europace 2007 9(7):544; doi:10.1093/europace/eum057
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
9/7/544    most recent
eum057v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Dontaraju, V. S.
Right arrow Articles by Skehan, J. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dontaraju, V. S.
Right arrow Articles by Skehan, J. D.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

Cardioverter-defibrillator box damage secondary to lead insulation defect

Venkata S. Dontaraju*, Ian Loke and John D. Skehan

Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Groby Road, Leicestershire LE3 9QP, UK

Manuscript submitted 29 January 2007. Accepted after revision 8 March 2007.

* Corresponding author. Tel: +44 7799671661. E-mail address: dontarajus{at}yahoo.com

A 39-year-old Caucasian female with hypertrophic obstructive cardiomyopathy and with history of syncope and other high-risk features for sudden cardiac death underwent implantation of St Jude Photon DR dual chamber cardioverter-defibrillator (ICD). Two years later she was found to be in atrial fibrillation and anticoagulated with warfarin. Three years after the ICD was implanted, it delivered an inappropriate single shock and was found to be in hardware reset mode with no defibrillator capacity. The device was explanted and sent to St Jude Medical for investigation. A new Medtronic Intrinsic ICD was implanted uneventfully and lead tested at device change. Defibrillation thresholds were deferred as she was in atrial fibrillation and not adequately anticoagulated. Few days later she collapsed and died. Device interrogation revealed ventricular tachycardia degenerated in to ventricular fibrillation and several unsuccessful shocks delivered.

Investigation of St Jude's device revealed a dent and an arc mark on the device box and Spectrography revealed the presence of lead material. It is believed that insulation of the high voltage lead was damaged and caused the lead to arc to the box during the high voltage therapy resulting in the damage to the box (dent and arc) and failure of energy delivery to heart. No defibrillator output was traced to shorted transistor. The battery longevity was normal.

So two ICDs from different manufacturers are damaged due to lead insulation defect. Along with other parameters, ICD boxes should be inspected for any obvious damage during box change.


Figure 1
View larger version (110K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Figure 1 Dent (top) and arc mark (bottom) on the Medtronic device box during post-mortem examination.

 


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
9/7/544    most recent
eum057v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Dontaraju, V. S.
Right arrow Articles by Skehan, J. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dontaraju, V. S.
Right arrow Articles by Skehan, J. D.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?