title: Unexpected ICD pulse generator failure due to electronic circuit damage caused by electrical overstress.
abstract: Because it is a lifesaving device, the unexpected failure of an ICD can be catastrophic. We report ICD electronic circuit failure due to electrical overstress damage (EOS) to the high voltage hybird circuit and other electronic components in a series of ICD pulse generator models. Data were obtained from the Multicenter Registry of  Pacemaker and ICD Pacemaker and Lead Failures, and from the  manufactures' adverse event reports, that were in the FDA's Manufacturer and User Facility Device Experience (MAUDE) database. Of 16 nonbattery Guidant/CPI ICD pulse generator failures reported to the registry, 6 (38%) have been confirmed by the manufacturer to be EOS related, and  Guidant/CPI has reported 273 such failures to the FDA as of 12/29/00. The signs of failure included loss of telemetry and inability to deliver therapy, and  some patients have experienced serious adverse events. Hybrid circuit damage may have occurred during capacitor charging or reform, and the majority appears to have happened during normal ICD function. While the incidence of this problem is unknown, a management strategy should be adopted that includes routine follow-up every 3 months and device evaluation after a shock or exposure to external defibrillation or electrosurgical devices. This study suggests that additional data are needed to determine the incidence of this problem, and that our present methods for monitoring the performance of ICD's following market release are inadequate.
authors.affiliation: Minneapolis Heart Institute Foundation, 920 E. 28th Street, Suite 300, Minneapolis, MN 55407, USA. rhauser747@aol.com
authors.forename: R G
authors.initials: RG
authors.lastname: Hauser
authors.forename: D L
authors.initials: DL
authors.lastname: Hayes
authors.forename: A K
authors.initials: AK
authors.lastname: Almquist
authors.forename: A E
authors.initials: AE
authors.lastname: Epstein
authors.forename: V
authors.initials: V
authors.lastname: Parsonnet
authors.forename: G F
authors.initials: GF
authors.lastname: Tyers
authors.forename: S C
authors.initials: SC
authors.lastname: Vlay
authors.forename: M H
authors.initials: MH
authors.lastname: Schoenfeld
mesh_terms: D017147:Defibrillators, Implantable; D004560:Electricity; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D013314:Stress, Mechanical