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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation

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Polarity-Dependent, Reduced or No-Output Shocks in Implantable Cardioverter-Defibrillators.

Charles D Swerdlow¹, Michael Ringle²

¹Smidt Heart Center, Cedars Sinai Medical Center, Los Angeles, California, USA.

JACC. Clinical Electrophysiology

|January 26, 2024

Summary

Implantable cardioverter-defibrillator shocks can fail due to feedthrough short circuits. A proposed mechanism explains polarity-dependent failures, where cathodal shocks create plasma, leading to device malfunction.

Keywords:

electrical breakdown feedthrough implantable cardioverter-defibrillator insulation breach shocks

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Published on: December 11, 2017

Area of Science:

Biomedical Engineering
Materials Science

Background:

Implantable cardioverter-defibrillators (ICDs) can experience polarity-dependent failures.
These failures are linked to structural issues in the high-voltage feedthrough, particularly during cathodal shocks.

Purpose of the Study:

To propose a mechanism explaining polarity-dependent shock failures in ICDs.
To investigate if this mechanism applies to other shock-induced short circuits.

Main Methods:

Analysis of the ICD feedthrough structure and its role in shock delivery.
Theoretical modeling of electrical field gradients, fluid vaporization, and electron field emission during shocks.
Comparison of conditions during cathodal and anodal shocks.

Main Results:

A fluid layer in the feedthrough, combined with electric field gradients, can cause water vaporization during shocks.
For cathodal shocks, electron emission from the inner pin can lead to ionization avalanche and plasma formation, causing a short circuit.
Anodal shocks result in a weaker electric field at the liquid-gas interface, stabilizing the gas bubble and preventing failure.

Conclusions:

The proposed mechanism explains polarity-dependent ICD shock failures.
This mechanism may also be relevant for other shock-induced short circuits in electronic devices.