Key result
ICD electrical short circuits cause fatal shock failure and total generator damage in ~75% of cases.
Why the study?
Electrical short circuits are rare but life-threatening complications in high-voltage ICDs, with limited ability to predict their occurrence in current systems.
What are the mechanisms and clinical consequences of electrical short circuits in high-voltage ICDs?
Case Report (n=4)
What are the mechanisms and clinical consequences of electrical short circuits in high-voltage ICDs?
Electrical short circuits in ICDs are rare but potentially fatal complications, suggesting the need to avoid lead stress, prefer single-coil leads, or use specific algorithms to disconnect shorted leads.
May indicate fatal ICD short-circuit risk; leaves open prospective evaluation of lead stress avoidance and coil configurations.
AIMS: 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. METHODS AND 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. CONCLUSION: 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.
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Tsurugi et al. (2015) conducted a case report in Electrical short circuit in high-voltage implantable cardioverter-defibrillator (ICD) (n=4). Electrical short circuit in high-voltage ICD was evaluated on Serious complications including failure of ICD shock, generator damage, and death. Electrical short circuits in ICDs caused failure to terminate ventricular tachycardia and total generator damage in 3 of 4 cases, resulting in 2 deaths.
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