Subcutaneous implantable cardioverter-defibrillator electrode fracture: Follow-up, troubleshooting, and evaluation

J Cardiovasc Electrophysiol. 2021 May;32(5):1452-1457. doi: 10.1111/jce.14994. Epub 2021 Mar 19.

Abstract

The subcutaneous-implantable cardioverter-defibrillator (S-ICD) and its electrode were developed to avoid long-term complications of transvenous leads in the vasculature. We report a case of unexpected, inappropriate S-ICD shocks due to oversensing of high-amplitude, nonphysiologic, electrical noise artifacts that were not preceded by high-impedance alerts or sensing electrogram noise detections. Following explant, high-magnification X-ray imaging of the S-ICD electrode demonstrated partial fracture of the distal sensing conductor located near a short radius bend in the electrode at the electrode-header interface. Clinicians should be aware of a potential for fatigue failure fracture of the S-ICD electrode. Recommendations for systematic S-ICD follow-up and troubleshooting are discussed.

Keywords: electrode fracture; inappropriate ICD therapy; oversensing; subcutaneous ICD.

Publication types

  • Case Reports

MeSH terms

  • Defibrillators, Implantable* / adverse effects
  • Follow-Up Studies
  • Humans
  • Subcutaneous Tissue
  • Treatment Outcome