Prevention of inappropriate ICD shocks due to lead insulation failure by continuous monitoring and automatic alert.
Patients with implantable cardioverter defibrillator lead insulation failures may present with oversensing and/or abnormal impedance. The Lead Integrity Alert (LIA) monitors right ventricular pace/sense leads using both continuous oversensing and daily impedance measurementd. Oversensing consists of isolated short R-R intervals and nonsustained runs of short R-R intervals. The LIA algorithm has been studied for Sprint Fidelis conductor fractures, but not for lead insulation failures. We report on a patient with a failed St. Jude Riata™ ST lead (St. Jude Medical, St. Paul, MN, USA) connected to a Medtronic Virtuoso DR (Medtronic Inc., Minneapolis, MN, USA) with the LIA. Oversensing triggered the LIA, while the impedance trend was normal.
Department of Medicine, Victorian Heart Centre, Epworth Hospital, Melbourne, Australia. rgelder@yahoo.com
Robert N
RN
Gelder
Bruce D
BD
Gunderson
D000465:Algorithms; D056902:Clinical Alarms; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004553:Electric Conductivity; D004556:Electric Injuries / Q000209:etiology* / Q000517:prevention & control; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation* / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004868:Equipment Failure; D006801:Humans; D008297:Male; D055815:Young Adult