Successful detection of a high-energy electrical short circuit and a “rescue” shock using a novel automatic shocking-vector adjustment algorithm Masahiro.

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Presentation transcript:

Successful detection of a high-energy electrical short circuit and a “rescue” shock using a novel automatic shocking-vector adjustment algorithm Masahiro Mizobuchi, MD, Yoshihisa Enjoji, MD HeartRhythm Case Reports Volume 1, Issue 1, Pages 27-30 (January 2015) DOI: 10.1016/j.hrcr.2014.10.005 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Intracardiac tracing during defibrillation threshold testing is shown. VF was induced ①. The first shock was implemented but failed to terminate VF. Note the exclamation point at the first shock. This mark denotes overcurrent detection. A high-voltage shock could not be delivered (“0 V”) ②. Subsequently, the next detection and charging sequence was executed. VF was successfully terminated using maximum shock delivery (875 V) of the “RV-CAN” shocking-vector configuration ③④. CAN = implantable cardioverter-defibrillator generator; DC = direct current; HV = high voltage; RV = right ventricle; VF = ventricular fibrillation. HeartRhythm Case Reports 2015 1, 27-30DOI: (10.1016/j.hrcr.2014.10.005) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 The analyzed data of defibrillation threshold testing are presented. A: Alert messages. B: The second shock vector was changed (RV-CAN), and the delivered shock was at its maximum energy (875 V). C: HV impedances and delivered shock energies are shown. CAN = implantable cardioverter-defibrillator generator; CL = cycle length; HV = high voltage; RV = right ventricle; SVC = superior vena cava; VF = ventricular fibrillation. HeartRhythm Case Reports 2015 1, 27-30DOI: (10.1016/j.hrcr.2014.10.005) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 A possible mechanism of an HV electrical short circuit between the RV and SVC coils is demonstrated (courtesy of St Jude Medical). An internal abrasion of the lumen of an RV conductor cable could have occurred underneath the SVC coil. HV = high voltage; RV = right ventricular; SVC = superior vena cava. HeartRhythm Case Reports 2015 1, 27-30DOI: (10.1016/j.hrcr.2014.10.005) Copyright © 2015 Heart Rhythm Society Terms and Conditions