Exploding Implantable Cardioverter Defibrillator


Address for correspondence: Michael O. Sweeney, M.D., Cardiac Arrhythmia Service, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Fax: 617-277-6289; E-mail: mosweeney@partners.org


Exploding Implantable Cardioverter Defibrillator. A 79-year-old man with a pectoral implantable cardioverter defibrillator (ICD) system underwent periodic defibrillation threshold testing 18 months after implant. Attempted delivery of a 15-J shock caused a light flash above the pocket and a loud “pop.” High-voltage lead impedance was < 20 Ω. Pocket exploration revealed insulation abrasion of the high-voltage portion of the single-coil right ventricular lead. The outer shield of the active can pulse was perforated and scorched due to arcing. Device analysis confirmed a shorted transistor in the high-voltage output circuit. Unsuspected physical contact between high-voltage electrodes of opposite polarity within the pocket can cause catastrophic ICD system failure.