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J Am Coll Cardiol, 2003; 41:73-80
© 2003 by the American College of Cardiology Foundation
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Detection and management of animplantable cardioverter defibrillator lead failure

Incidence and clinical implications

Kenneth A. Ellenbogen, MD, FACC*,*, Mark A. Wood, MD, FACC*, Richard K. Shepard, MD*, Henry F. Clemo, MD, PhD, FACC*, Tim Vaughn, BS{dagger}, Keith Holloman, BA{dagger}, Marlene Dow, RN{dagger}, Jeanne Leffler, RN*, Athula Abeyratne, PhD{dagger} and Dave Verness, BS, PE, CQE{dagger}

* Division of Cardiology, Medical College of Virginia/Virginia Commonwealth University, Richmond, Virginia, USA
{dagger} Medtronic, Inc., Minneapolis, Minnesota, USA



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  		Figure 1 Schematic diagram of Medtronic 6936 coaxial tripolar implantable cardioverter defibrillator lead. HVB = high voltage distal coil; P/S = pace/sense.

 


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  		Figure 2 Flow chart for all patients undergoing implantation of the Medtronic 6936 implantable cardioverter defibrillator (ICD) lead. Current clinical status for all ICD leads is summarized. DFT = defibrillation threshold; EGM = electrograms.

 


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  		Figure 3 Stored intracardiac electrograms from a patient presenting with sustained monomorphic ventricular tachycardia (rate, 200 beats/min) associated with lightheadedness and dizziness. The patient received an appropriate shock for ventricular tachycardia, which terminated this arrhythmia, then received a total of five additional inappropriate shocks due to oversensing during sinus rhythm immediately after appropriate therapy was delivered.

 


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  		Figure 4 Kaplan-Meier survival curve for the Medtronic 6936 implantable cardioverter defibrillator lead.

 


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  		Figure 5 Two graphs demonstrating examples of patients with measurement of implantable cardioverter defibrillator (ICD) ring-to-coil impedance with translation software. (A) A drop in lead impedance (down arrow) precedes an inappropriate detection (up arrow) by a period of over 20 weeks. (B) A drop in lead impedance (down arrow) preceded ICD lead failure and need for lead extraction by almost one year. Lead extraction was performed in this patient before delivery of inappropriate shocks. Both of these patients underwent microscopic examination of the leads confirming the presence of metal ion oxidation breaching. VF = ventricular fibrillation.

 




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