Key result
An automatic impedance monitoring and alert feature in an ICD failed to detect an intermittent lead fracture, leading to device malfunction and sudden death from ventricular fibrillation.
Case Report (n=1)
Automatic impedance monitoring features in ICDs may fail to detect intermittent lead fractures, highlighting a critical limitation that can lead to fatal outcomes.
Impedance alerts may miss intermittent ICD lead fractures; case reports leave open need for supplementary monitoring strategies.
Recent advances in implantable cardioverter defibrillator (ICD) technology have enabled implementation of an automatic monitoring feature in ICDs that provides daily measurements of several technical parameters such as battery status, pacing, and high-voltage impedance. The system alerts the patient with an audible alarm to contact the physician in case the measured parameters are not within normal limits. Early detection of intermittent and potentially serious complications justifies routine use of this feature. This report describes a patient with an ICD who died suddenly due to ventricular fibrillation, which was not appropriately treated by the device. The cause of device malfunction was most likely an intermittent lead fracture that was not detected by the automatic impedance monitoring and alert feature of this device. Based on these data, potential benefits and theoretical pitfalls of automatic impedance monitoring and alert features are discussed.
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Duru et al. (2005) conducted a case report in Ventricular fibrillation in a patient with an implantable cardioverter defibrillator (n=1). Automatic impedance monitoring and patient alert feature was evaluated. An automatic impedance monitoring and alert feature in an ICD failed to detect an intermittent lead fracture, leading to device malfunction and sudden death from ventricular fibrillation.
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