Catastrophic failure of Durata ICD lead due to high-voltage short during shock delivery

Case report A 49-year-old woman with hypertrophic cardiomyopathy and family history of sudden cardiac arrest underwent placement of a dual-chamber implantable cardioverter-defibrillator (ICD) in July 2008 for the primary prevention of sudden cardiac arrest. Her implanted hardware included a St Jude Medical (Sylmar, California) Current DR RF model 2207-36 pulse generator, Optisense model 1699TC right atrial lead, and Durata model 7120 right ventricular (RV) ICD lead. Her medications included metoprolol. She was asymptomatic and exercised regularly. She declined remote monitoring but kept regular office visits. In July 2013, office ICD testing was normal including daily device-based, high-voltage lead integrity testing measurements. There were no arrhythmia detections. In December 2013, she suffered a cardiac arrest at a shopping mall. Bystanders performed cardiopulmonary resuscitation for an estimated 15 minutes before paramedics arrived. Her presenting rhythm upon squad arrival was ventricular fibrillation. She required multiple defibrillations before sinus rhythm was restored. She was intubated and placed on hypothermia protocol. Her ICD was interrogated and noted to have o10 Ω impedance during shock delivery for ventricular fibrillation. The shock failed and ventricular fibrillation persisted. After intensive care unit care, she had a complete hemodynamic and neurologic recovery. She was taken to the electrophysiological laboratory and underwent explant of the ICD pulse generator and extraction of the Durata ICD lead. Visually, the ICD lead appeared normal. A newRV ICD lead and a pulse generator were successfully placed. Her explanted hardware was returned to St Jude Medical for analysis.