Outer insulation failure in a multilumen ICD lead

Insulation defects in the leads are a common complication in implantable cardioverter-defibrillators (ICDs). Although the new multilumen leads have significantly reduced the incidence of insulation defects, they have introduced the new and rare problem of outer-insulation abrasions. In this report, we present the case of a 53-year-old man with dilated cardiomyopathy who was found to have an outer-insulation abrasion on fluoroscopy 3 years after the implantation of an ICD. Several electrical storms experienced by the patient were considered to be responsible for the abrasions; results of routine evaluations were normal. A CRT-D device was finally implanted.