Diathermy-induced ventricular fibrillation with Riata high-voltage lead insulation failure.

A 76-year-old man presented after a series of six shocks in quick succession from his implanted biventricular defibrillator, without relief of palpitations and pre-syncope. Initial 12-lead electrocardiogram revealed ventricular tachycardia at 180 b.p.m. One 200 J external shock was delivered with successful return to sinus rhythm. Interrogation of the device revealed that the device had been reset. Neither the episodes nor the therapies delivered were accessible. The patient was taken to the cardiac catheterization lab for a replacement. During dissection to free the leads ventricular fibrillation was noted immediately following diathermy application. Three external 200 J shocks were required to return to sinus rhythm. Further dissection without diathermy revealed a clear insulation failure of the high-voltage lead (Figure 1). To the best of our knowledge diathermyinduced ventricular fibrillation, as a result of insulation failure, has not been reported previously.