GB Pant's cardiology team demonstrates novel postural variations in ICD lead parameters, case reported in EHJ.
Figure 1. Electrogram recording showing high frequency, high amplitude noise signal on ventricular electrogram leading to an antitachycardia pacing therapy (shown as STIM annotation) which is then followed by 30 J high voltage shock. No noise is detected on atrial electrogram trace.
Table 1
In a first of its kind case-report, interventional cardiologists from Delhi's GB Pant have described a unique postural variation that can unmask an underlying dysfunction in Riata Implantable-cardioverter-defibrillator (ICD) leads. This interesting case report has report has now been published in the European Heart Journal-Case reports.
Riata implantable cardioverter-defibrillator (ICD) leads are prone to a unique type of mechanical lead failure causing conductor externalization (CE) which may be complicated by a delayed-onset electrical lead failure (ELF).
A 60-year-old male with symptomatic, severe ischaemic cardiomyopathy, and atrial fibrillation following a prior anterior wall myocardial infarction received a dual-chamber ICD with 7F-RiataST ventricular lead as a primary prevention strategy against sudden cardiac death in 2008. In 2017, a pulse generator replacement was performed for elective replacement indicator status.
At that time, CE was noted in the ventricular lead but the electrical lead parameters were normal, hence lead replacement was decided against and the patient was closely followed up thereafter. Four years later, the patient presented with multiple ICD shocks within 48 h.
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