A Better Method for Preventing Adverse Clinical Events Caused by Implantable Cardioverter-Defibrillator Lead Fractures?

the Medtronic Sprint Fidelis implantable cardioverter-defibrillator (ICD) lead was voluntarily withdrawn from the market by the manufacturer because of a higher-than-expected fracture rate. 1 Most Sprint Fidelis fractures involve the pace-sense component of the lead, which may cause oversensing of electrical artifacts, undersensing of ventricular depolarizations, and/or loss of ventricular capture. Approximately 10% to 20% of Sprint Fidelis fractures involve the high-voltage conductor, which may compromise defibrillation. ] ICD lead failures are more likely to result in oversensing than pacemakers because the ICD pulse generators use high-sensitivity amplifiers to effectively detect ventricular fibrillation (VF). In this issue of Circulation, Swerdlow et al 7 describe a new algorithm that may avoid or reduce inappropriate shocks and other serious adverse events in patients with failed Sprint Fidelis and possibly other highvoltage leads. If this algorithm proves to be safe and effective, it will be an important advance in ICD therapy.