Exploding implantable cardioverter defibrillator.
A 79-year-old man with a pectoral implantable cardioverter defibrillator (ICD) system underwent periodic defibrillation threshold testing 18 months after implant. Attempted delivery of a 15-J shock caused a light flash above the pocket and a loud "pop." High-voltage lead impedance was <20 ohms. Pocket exploration revealed insulation abrasion of the high-voltage portion of the single-coil right ventricular lead. The outer shield of the active can pulse was perforated and scorched due to arcing. Device analysis confirmed a shorted transistor in the high-voltage output circuit. Unsuspected physical contact between high-voltage electrodes of opposite polarity within the pocket can cause catastrophic ICD system failure.
Sweeney
M O
MO
Cardiac Arrhythmia Service, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. mosweeney@partners.org
D000368:Aged; D009202:Cardiomyopathies / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004868:Equipment Failure; D005107:Explosions; D006801:Humans; D008297:Male; D014693:Ventricular Fibrillation / Q000628:therapy