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Antitachycardia Pacing Therapy for the Successful Treatment of Lead Fracture.
MedLine Citation:
PMID:  25354719     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
A 35-year-old man with non-ischemic cardiomyopathy underwent a single chamber implantable cardioverter defibrillator (ICD) implant with a St. Jude Medical Fortify VR pulse generator and an active fixation ventricular lead (St. Jude Durata model 7121, 65 cm) for the primary prevention of sudden cardiac arrest. Twenty months after device implant, he presented to our clinic for evaluation of a "funny sensation" in his chest. Device evaluation revealed ventricular sensing amplitude 2.4 mV, lead impedance 1500 ohms, and pacing capture threshold was 2.0 V @ 0.5 msec, which were all stable over the prior 6 months. The tachycardia detections were set for two zones: ventricular tachycardia (VT), 181-221 beats per minute (bpm), and ventricular fibrillation (VF), greater than 221 bpm. Antitachycardia pacing (ATP) therapies were programmed in both zones. In addition to several nonsustained VF events, there were two episodes of tachycardia in the VF zone, occurring on different days, for which ATP was delivered and noted to be successful (Figure 1). The figure shows electrical noise on the bipolar signal that was not seen on the far-field signal and did not correlate with any causes of external noise according to the patient. Interestingly, the noise disappeared instantly after ATP on both occasions. Though this phenomenon has been reported after some ICD shocks, the reasons have not been clarified. Polarization of the conductor allowing normal signal transmission is a possibility or a new position of the lead or patient as a result of the ICD therapy may explain the loss of lead noise. As a result, Figure 1 shows what appears to be effective therapy for lead fracture noise using ATP. Nonetheless, due to the diagnosis of lead fracture (without conductor externalization), he underwent successful right ventricular lead replacement. This article is protected by copyright. All rights reserved.
Authors:
Ashish A Bhimani; Peerawut Deeprasertkul; Nischala Nannapaneni; George N Carayannopoulos
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-10-29
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2014 Oct 
Date Detail:
Created Date:  2014-10-30     Completed Date:  -     Revised Date:  2014-10-31    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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