Lead breakage on an older model

Summary

• Episode of non-sustained VF with shock abandoned

• The lead is the weak link in the defibrillation system, with a percentage of malfunction that varies depending on the model.
• This trace is highly suggestive of a lead break (short cycles approaching
• ventricular refractory period, most often detected in the VF zone, intermittent in the cardiac cycle, anarchic, of variable amplitude, some signals saturating the amplifiers); these are rupture potentials highly suggestive of a conductor rupture rather than an insulation defect
• in this asymptomatic patient, telemedicine enabled early diagnosis and prevented inappropriate therapies from being administered; similarly, early diagnosis prevents a series of inappropriate charges, which, even if they are diverted, consume energy and reduce the device’s lifespan
• When a lead malfunctions, abnormalities generally occur in several stages: initially, the device’s memory may record multiple episodes of non-sustained VT without any abnormalities in the lead measurements; Second, if the diagnosis has not been made by the monitoring team, a clear break in the various impedance, threshold, and right ventricular ventricular sensing curves may be observed. The duration of oversensing episodes increases, which can lead to multiple electric shocks, a particularly traumatic experience for the patient concerned.