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Related Experiment Videos

Exploding implantable cardioverter defibrillator.

M O Sweeney1

  • 1Cardiac Arrhythmia Service, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. mosweeney@partners.org

Journal of Cardiovascular Electrophysiology
|January 19, 2002
PubMed
Summary

A pectoral implantable cardioverter defibrillator (ICD) system failed due to lead abrasion and arcing. This highlights the risk of unexpected contact between ICD electrodes within the device pocket, leading to system malfunction.

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Device Technology

Background:

  • Implantable cardioverter defibrillator (ICD) systems are crucial for managing life-threatening arrhythmias.
  • Routine defibrillation threshold testing is performed to ensure device efficacy.
  • Lead integrity and proper device placement are critical for safe ICD function.

Observation:

  • During testing, a 79-year-old patient experienced a visible light flash and audible pop when a 15-J shock was attempted.
  • Low high-voltage lead impedance (<20 ohms) was measured, indicating a potential system short.
  • Exploration revealed insulation abrasion on the right ventricular lead and perforation/scorching of the active can pulse.

Findings:

  • The ICD system failure was attributed to insulation abrasion of the high-voltage lead.

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  • Arcing between the lead and the active can perforated and scorched the can's outer shield.
  • Device analysis confirmed a shorted transistor in the high-voltage output circuit.

    • Implications:

    • Physical contact between high-voltage electrodes of opposite polarity within the ICD pocket can lead to catastrophic system failure.
    • This case underscores the importance of meticulous surgical technique and device management to prevent lead-device interactions.
    • Awareness of potential lead abrasion and arcing is crucial for device troubleshooting and patient safety.