Failure of Lead Integrity Alert to detect implantable cardioverter-defibrillator lead-system failure in a pacemaker-dependent patient

Figure 1. A single high-rate ventricular episode recorded 2 months prior to the onset of the patient’s symptoms, consistent with oversensing owing to probable electrical noise.

Figure 2. Event monitor recorded a 9-second asystole episode during nighttime.

Figure 3. A: Right ventricular (RV) bipolar and tip-to-coil lead impedance trends averaged weekly over the last 80 weeks and daily over the past 15 days prior to presentation. B: Manufacturer performance data analysis showing biweekly measurements (minimum and maximum) of the RV bipolar, ring-to-coil, and tip-to-coil impedances. Notable are the trends demonstrating variable increases in the RV bipolar and ring-to-coil maximum impedances, which are not seen on the RV tip-to-coil impedances.

Supplementary Figure 1.