Defibrillation failure with short ICD charge time: Internal short circuit of a Durata lead

Abstract

A 17-year-old male with hypertrophic cardiomyopathy underwent placement of a dual-chamber implantable cardioverter defibrillator (ICD) in 2010. In October 2016, he suffered a cardiac arrest. His ICD was interrogated after visiting our hospital. The shock failed, and ventricular fibrillation (VF) terminated spontaneously to sinus rhythm. The Durata lead (SJM, Sylmar, CA, USA) was removed for investigation. The lead had an internal abrasion of a right ventricular conductor cable at the superior vena cava coil. These findings suggest that the ICD shocks that failed to terminate the VF were delivered with low energy due to an internal short circuit of the Durata lead. The very short charge time indicates insufficient energy delivery, which may cause failure of cardioversion and defibrillation. <Learning objective: An internal short circuit of an implantable cardioverter defibrillator lead can cause ineffective defibrillation, which has been reported with the Riata lead (SJM, Sylmar, CA, USA). However, the next-generation Durata lead (SJM) has been considered more reliable, since it is covered with the silicone-polyurethane co-polymer Optim to reduce abrasion failure, making it less susceptible to failure than the previous Riata and Riata ST leads. However, an Achilles heel of the Durata lead is the underside of the shock coil, which is not covered with Optim.>