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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Limitation of programmed alerts to predict ICD lead failures
1Stony Brook Arrhythmia Study and Sudden Death Prevention Center, Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, New York 11794, USA. svlay@notes.cc.sunysb.edu
Pacing and Clinical Electrophysiology : PACE
|April 2, 2009
Summary
Sudden failure of implantable cardioverter-defibrillator (ICD) leads can cause inappropriate shocks. Standard impedance monitoring may not detect all lead failures before critical events occur.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Device Technology
Background:
- Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening arrhythmias.
- Lead integrity is paramount for ICD function, with impedance monitoring a key safety feature.
Observation:
- A 75-year-old patient experienced inappropriate shocks due to a Sprint Fidelis ICD lead failure.
- The failure involved the right ventricular (RV) pace-sense connector, leading to signal noise.
Findings:
- RV pacing impedance increased from baseline (450-550 Omega) to 750 Omega, then to 1,552 Omega during therapy delivery.
- The impedance rise occurred before audible alerts, indicating limitations in current monitoring parameters.
Implications:
- Manufacturer-recommended impedance alert levels may not reliably predict all ICD lead failures.
- Clinical vigilance and potentially revised monitoring protocols are needed to ensure patient safety.
- This case highlights the need for advanced diagnostics in ICD lead performance assessment.
