title: Covering sleeves can shield the high-voltage coils from lead chatter in an integrated bipolar ICD lead.
abstract: OBJECTIVE
  Integrated bipolar implantable cardioverter-defibrillator (ICD) leads use the distal high-voltage coil as both the ventricular sensing anode and the distal shocking electrode. Mechanical interactions between the distal ICD coil and other intracardiac leads have been reported to result in electrical oversensing and inappropriate ICD therapies. We sought to determine whether covering sleeves over the high-voltage coils of an integrated bipolar ICD lead could prevent sensed artefact from mechanical lead interactions.
  
  
  RESULTS
  Endotak Reliance 0157 and Endotak Reliance-G 0185 leads, the latter with expanded polytetrafluoroethylene (ePTFE) sleeves covering the high-voltage coils, were connected to ICD generators and the leads were submerged in saline. Device programmers were used to communicate with the ICD generators, providing real-time electrogram recording throughout testing. A series of mechanical interactions were performed with the ICD leads, including sliding and striking each distal coil against metal and non-metal components of other ICD and pacemaker leads. All direct metal-metal interactions resulted in sensed electrical artefact, including interactions between the bare ICD coil and another bare ICD coil or metal pacemaker ring. Identical mechanical interactions where metal-metal contact was prevented due to an interposed ePTFE covering sleeve were electrically silent with no sensed artefact.
  
  
  CONCLUSIONS
  A covering sleeve over the distal high-voltage coil of an integrated bipolar ICD lead can mechanically shield the lead from metal-metal interactions, which might otherwise result in sensed artefact and inappropriate ICD therapies or withholding of pacing output. This finding has implications for lead selection when a new ICD lead is to be implanted adjacent to abandoned intracardiac leads or lead fragments.
authors.affiliation: University of Pennsylvania Health System, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA. joshua.cooper@uphs.upenn.edu
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Cooper
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Krautkramer
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Verdino
mesh_terms: D016477:Artifacts; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D004562:Electrocardiography; D004567:Electrodes, Implanted; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D008670:Metals; D011138:Polytetrafluoroethylene; D015203:Reproducibility of Results; D012965:Sodium Chloride
chemical_list: D008670:Metals; D012965:Sodium Chloride; D011138:Polytetrafluoroethylene