Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) Electrode Fracture: Follow-up, Troubleshooting and Evaluation.

The subcutaneous-ICD (S-ICD) and its electrode were developed to avoid long-term complications of transvenous leads in the vasculature. We report a case of unexpected, inappropriate S-ICD shocks due to oversensing of high amplitude, non-physiologic, electrical noise artifacts that were not preceded by high impedance alerts or sensing electrogram noise detections. Following explant, high-magnification, X-ray imaging of the S-ICD electrode demonstrated partial fracture of the distal sensing conductor located near a short radius bend in the electrode at the electrode-header interface. Clinicians should be aware of a potential for fatigue failure fracture of the S-ICD electrode. Recommendations for systematic S-ICD follow-up and troubleshooting are discussed. This article is protected by copyright. All rights reserved.