Goldstein Matthew A, Badri Marwan, Kocovic Dusan, Kowey Peter R
Lankenau Medical Center and Institute for Medical Research, Main Line Health System, Wynnewood, Pennsylvania.
Pacing Clin Electrophysiol. 2013 Sep;36(9):1068-71. doi: 10.1111/pace.12187. Epub 2013 Jun 3.
A 55-year-old male patient presented after a single shock caused by oversensing of isolated nonphysiologic signals on both the distal HV and pace-sense channels. No other abnormalities were found. He subsequently returned complaining of device "vibration" and his St. Jude implantable defibrillator (ICD; St. Jude Medical, St. Paul, MN, USA) was found to be in VVI backup mode and could not be interrogated. Direct testing in the electrophysiology lab showed normal lead impedances and thresholds with an inability to reproduce the abnormal signals. Detailed cine fluoroscopy of the leads found no abnormalities. A new ICD was connected and successfully delivered a 20-joule shock but failed to deliver a maximum output (39-joule) shock. The new ICD was again found to be in backup mode. A new Endotak Reliance G lead (Boston Scientific, Natick, MA, USA) was implanted and a maximum-output shock was successful using a new Fortify DR ICD. This case likely represents a Durata lead insulation defect in the form of an inside-out abrasion under the distal HV coil. Increased awareness of this defect is warranted, particularly since routine interrogation and submaximum-output shocks may fail to detect the problem.
一名55岁男性患者因远端希氏束（HV）和起搏感知通道上孤立的非生理性信号过度感知导致单次电击后前来就诊。未发现其他异常。随后他因设备“震动”复诊，发现其圣犹达植入式心律转复除颤器（ICD；圣犹达医疗公司，美国明尼苏达州圣保罗）处于VVI备用模式，无法进行问询。在电生理实验室进行的直接测试显示导线阻抗和阈值正常，但无法重现异常信号。对导线进行详细的荧光透视检查未发现异常。连接了一台新的ICD，它成功发放了20焦耳的电击，但未能发放最大输出（39焦耳）的电击。再次发现新的ICD处于备用模式。植入了一根新的Endotak Reliance G导线（美敦力公司，美国马萨诸塞州纳蒂克），使用新的Fortify DR ICD成功发放了最大输出电击。该病例可能代表了远端HV线圈下方出现由内向外磨损形式的Durata导线绝缘缺陷。有必要提高对这种缺陷的认识，特别是因为常规问询和次最大输出电击可能无法检测到该问题。
