Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) Electrode
Fracture: Follow-up, Troubleshooting and Evaluation
Abstract
Introduction: The subcutaneous-ICD (S-ICD) and its electrode were
developed to avoid long-term complications of transvenous leads in the
vasculature. Methods: We report a case of unexpected, inappropriate
S-ICD shocks due to oversensing of high amplitude, non-physiologic,
electrical noise artifacts that were not preceded by high impedance
alerts or sensing electrogram noise detections. Results: Following
explant, high-magnification, X-ray imaging of the S-ICD electrode
demonstrated partial fracture of the distal sensing conductor located
near a short radius bend in the electrode at the electrode-header
interface. Conclusions: Clinicians should be aware of a potential for
fatigue failure fracture of the S-ICD electrode. Recommendations for
systematic S-ICD follow-up and troubleshooting are discussed.