Header bonding failure in a prepectoral implantable cardioverter-defibrillator

Excerpt

A 56-year-old man was referred to the electrophysiology clinic for ICD interrogation. His medical history includes ischemic cardiomyopathy with an ICD implanted in 1998. His last generator was changed 8 years ago, when a Boston Scientific E 110 Teligen generator was implanted in the prepectoral site. He denies history of trauma to the chest, although he sometimes wrestles with his grandchildren. There was no tenderness or erythema at the device site. Device interrogation showed normal sinus rhythm. The device recorded 9 non-sustained ventricular tachycardia (NSVT) episodes. Upon review, these episodes were thought to be due to sensing artifact. No shocks were delivered. Sensing, thresholds, and lead impedance were stable. HV impedance was abruptly increased to 123 ohms and was fluctuating. Atrial threshold measured 2 0 V at 0.8 ms. The patient was atrial-paced 2% and ventricular-paced at < 1%. The device was at replacement indicator and the decision was made to change the generator. In the electrophysiology laboratory, there was sensing artifact noted on the shock electrogram and increased HV impedance of 100 ohms. The ICD header was found to be loosened during pocket exploration (Fig. 1). The explanted device was returned to Boston Scientific although no analysis was received at this time. A St. Jude Abbott 2357-40C generator was implanted.

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