title: Various mechanisms and clinical phenotypes in electrical short circuits of high-voltage devices: report of four cases and review of the literature.
abstract: OBJECTIVE
  An electrical short circuit is a rare complication in a high-voltage implantable cardioverter-defibrillator (ICD). However, the inability of an ICD to deliver appropriate shock therapy can be life-threatening.
  
  
  RESULTS
  During the last 2 years, four cases of serious complications related to an electrical short circuit have been reported in Japan. A spark due to an electrical short circuit resulted in the failure of an ICD shock to terminate ventricular tachycardia and total damage to the ICD generator in three of four cases. Two of the four patients died from an electrical short circuit between the right ventricle and superior vena cava (SVC) leads. The others had audible sounds from the ICD generator site and were diagnosed with a lead-to-can abrasion, which was manifested by the arc mark on the surface of the can.
  
  
  CONCLUSIONS
  It is still difficult to predict the occurrence of an electrical short circuit in current ICD systems. To reduce the probability of an electrical short circuit, we suggest the following: (i) avoid lead stress at ICD implantation, (ii) select a single-coil lead instead of a dual-coil lead, or (iii) use a unique algorithm which automatically disconnect can or SVC lead from shock deliver circuit when excessive current was detected.
authors.affiliation: Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1, Chikami, Minami-ku, Kumtamoto 861 4193, Japan takuo-tsurugi@saiseikaikumamoto.jp.
authors.forename: Takuo
authors.initials: T
authors.lastname: Tsurugi
authors.affiliation: Hiroshima City Hospital, Hiroshima, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Matsui
authors.affiliation: Japan Research Institute for Device Therapy, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Nishii
authors.affiliation: Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1, Chikami, Minami-ku, Kumtamoto 861 4193, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Honda
authors.affiliation: Gunma University Graduate School of Medicine, Gunma, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kaneko
mesh_terms: D000328:Adult; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D017097:Electric Impedance; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000628:therapy*
keywords: Arc mark; Electrical short circuit; ICD; Lead insulation failure