Takuo Tsurugi1, Shogo Matsui2, Hiroshi Nakajima3, Nobuhiro Nishii4, Toshihiro Honda5, Yoshiaki Kaneko6. 1. Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1, Chikami, Minami-ku, Kumtamoto 861 4193, Japan takuo-tsurugi@saiseikaikumamoto.jp. 2. Hiroshima City Hospital, Hiroshima, Japan. 3. Japan Research Institute for Device Therapy, Japan. 4. Okayama University Graduate School of Medicine, Okayama, Japan. 5. Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1, Chikami, Minami-ku, Kumtamoto 861 4193, Japan. 6. Gunma University Graduate School of Medicine, Gunma, Japan.
Abstract
AIMS: An electrical short circuit is a rare complication in a high-voltage implantable cardioverter-defibrillator (ICD). However, the inability of an ICD to deliver appropriate shock therapy can be life-threatening. METHODS AND RESULTS: During the last 2 years, four cases of serious complications related to an electrical short circuit have been reported in Japan. A spark due to an electrical short circuit resulted in the failure of an ICD shock to terminate ventricular tachycardia and total damage to the ICD generator in three of four cases. Two of the four patients died from an electrical short circuit between the right ventricle and superior vena cava (SVC) leads. The others had audible sounds from the ICD generator site and were diagnosed with a lead-to-can abrasion, which was manifested by the arc mark on the surface of the can. CONCLUSION: It is still difficult to predict the occurrence of an electrical short circuit in current ICD systems. To reduce the probability of an electrical short circuit, we suggest the following: (i) avoid lead stress at ICD implantation, (ii) select a single-coil lead instead of a dual-coil lead, or (iii) use a unique algorithm which automatically disconnect can or SVC lead from shock deliver circuit when excessive current was detected. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: An electrical short circuit is a rare complication in a high-voltage implantable cardioverter-defibrillator (ICD). However, the inability of an ICD to deliver appropriate shock therapy can be life-threatening. METHODS AND RESULTS: During the last 2 years, four cases of serious complications related to an electrical short circuit have been reported in Japan. A spark due to an electrical short circuit resulted in the failure of an ICD shock to terminate ventricular tachycardia and total damage to the ICD generator in three of four cases. Two of the four patients died from an electrical short circuit between the right ventricle and superior vena cava (SVC) leads. The others had audible sounds from the ICD generator site and were diagnosed with a lead-to-can abrasion, which was manifested by the arc mark on the surface of the can. CONCLUSION: It is still difficult to predict the occurrence of an electrical short circuit in current ICD systems. To reduce the probability of an electrical short circuit, we suggest the following: (i) avoid lead stress at ICD implantation, (ii) select a single-coil lead instead of a dual-coil lead, or (iii) use a unique algorithm which automatically disconnect can or SVC lead from shock deliver circuit when excessive current was detected. Published on behalf of the European Society of Cardiology. All rights reserved.