Dislodgement of the defibrillation lead in the atrium
Tracing
Manufacturer Boston Scientific
Device ICD
Field Sensing
N° 6
Patient
This 65-year-old man received a Boston Science single chamber defibrillator for secondary prevention of sustained VT with syncope and ischemic cardiomyopathy. The day after implantation, he perceived an electrical shock.
Graph and trace
Tracing
- sensing of clearly visible atrial activity on the ventricular high-voltage channel and intermittent sensing of ventricular activity;
- complete undersensing of ventricular activity with intermittent sensing of atrial activity;
- ineffective ventricular pacing, falling in the refractory period of a non-sensed spontaneous QRS;
- onset of atrial tachycardia detected at the level of the ventricular channel;
- detection of an episode in the VF zone, charge of the capacitors and inappropriate electrical shock (not visible), which, however, terminated the episode of atrial tachycardia.
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This tracing is consistent with the early dislodgement of the defibrillation lead. A chest X-ray showed a lead floating inside the atrial chamber. Pending the lead repositioning, the therapies were temporarily turned OFF to prevent the occurrence of further inappropriate therapies.