Unusual fracture in a Durata lead with shock coil fragmentation and cable externalization Toshiaki Sato, MD, Kyoko Soejima, MD, Hideaki Yoshino, MD,

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Presentation transcript:

Unusual fracture in a Durata lead with shock coil fragmentation and cable externalization Toshiaki Sato, MD, Kyoko Soejima, MD, Hideaki Yoshino, MD, Morio Shoda, MD HeartRhythm Case Reports Volume 3, Issue 7, Pages 327-331 (July 2017) DOI: 10.1016/j.hrcr.2017.03.006 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Fluoroscopic views of the leads. A: right anterior oblique view, diastolic phase; B: systolic phase; C: left anterior oblique view, diastolic phase; D: systolic phase. The right ventricular (RV) shock coil was torn off and coil fragments were embolized in the right ventricle. The piece of residual shock coil protruded from the lead body. The bottom edge of the pacemaker lead was scraping the defibrillation lead between split RV shock coils (Supplementary Video available online). HeartRhythm Case Reports 2017 3, 327-331DOI: (10.1016/j.hrcr.2017.03.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Spike potentials on T wave recorded by right ventricular (RV) pacemaker lead and then implantable cardioverter-defibrillator (ICD) lead. A: An ICD generator was connected to the residual pacemaker lead for RV septal pacing and sensing. T-wave synchronous spike potentials were oversensed prior to delivery of inappropriate shock. B: The defibrillation lead was then used for RV apical pacing and sensing. The nonphysiological potentials were apparent after RV sensing or RV pacing and on or just after T wave. A marker channel with atrial and ventricular intervals is also shown. Asterisks on the marker channel denote oversensed signals. HeartRhythm Case Reports 2017 3, 327-331DOI: (10.1016/j.hrcr.2017.03.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 The defibrillation lead and the pacemaker lead. A: The extracted shock lead is shown. The broken end of the right ventricular (RV) shock coil protruded from the lead body (*). B, C: External abrasion through the RV shock coil and breaching of the ring electrode lumen is noted at 4.5 cm and 8.2 cm from the distal tip. D: The insulation and ring electrode cables were broken at 5.0 cm from the distal tip of the pacemaker lead. Flattened conductors owing to friction between leads were apparent in the ring electrode cables of the pacemaker lead (E) as well as the residual RV shock coil (B). HeartRhythm Case Reports 2017 3, 327-331DOI: (10.1016/j.hrcr.2017.03.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions