Turning a blind eye to the far field: Are we burying the evidence? A case of abrupt catastrophic implantable cardioverter defibrillator lead failure causing sudden death

Introduction Implantable cardioverter defibrillator (ICD) therapy is commonly used for the prevention of sudden arrhythmic death in high risk populations. A recognized complication of such therapy is lead failure, leading to potential inappropriate detection and delivery of high energy defibrillation shocks. Many modern devices utilize algorithms which can differentiate between lead noise and true arrhythmia, avoiding unnecessary therapies. However, the programming of these algorithms can be the difference between life and death. Below is presented a case of lead failure in which the default programming of the device’s algorithms contributed to a catastrophic outcome which was potentially avoidable.