Stored intracardiac electrograms can be essential for diagnosing ICD lead fractures causing inappropriate shocks when other methods are insufficient.
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Stored intracardiac electrograms may aid diagnosis of costoclavicular ICD lead fractures; leaves open broader applicability pending prospective data.
An implantable cardioverter defibrillator is an important therapeutic option for patients with high risk of life-threatening ventricular arrhythmias. However, their use is also associated with several complications including inappropriate shock. Although the most frequent cause of inappropriate shock is supraventricular tachyarrhythmias, lead fracture can also be associated with inappropriate shock. Diagnosis of lead fracture can be made by chest x-ray radiography, fluoroscopic examination, interrogation of the device, and intracardiac electrograms. In this report, the authors present two cases of inappropriate shock due to lead fractures in the costoclavicular region that could only be diagnosed by the help of stored intracardiac electrograms. Methods for diagnosis of lead fractures and modalities to avoid recurrences are also discussed.
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Oto et al. (2000) studied this question.
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