Innovative endovascular defibrillator lead use in superior vena cava obstruction.

BACKGROUND: We describe an unusual case of severe heart failure (HF) and rapid atrial fibrillation (AF) improved through ablation and pacemaker implant despite superior vena cava obstruction (SVCO). METHODS: SVCO precluded upper body venous access to the heart for procedural rate control. Both AV Junctional ablation and permanent endovascular lead placement were achieved through the inferior vena cava (IVC). RESULTS: Clinical improvement from NYHA Class IV to Class II HF was observed with effective nonpharmacologic ventricular rate control. CONCLUSIONS: HF patients with rapid AF and SVCO can achieve ventricular rate control through lower body venous access to the heart utilizing 100-cm endovascular defibrillator rate sensing leads.

Audible implantable cardioverter defibrillator alarms detect intermittent conductor discontinuity.

The lead conductor integrity of implantable cardioverter defibrillator devices is inferred from impedance measurements; however, intermittent discontinuity can be difficult to detect or confirm. Newer devices can perform daily lead impedance self-testing, and some even have audible alarms that promptly warn patients of anomalies. In the present case, the audible alarms were solely responsible for the timely identification of an intermittent, otherwise clinically nonreproducible, form of potentially fatal implantable cardioverter defibrillator system failure.

ICD nocardiosis.

We present an initial report of Nocardia asteroides implantable cardioverter defibrillator infection. Systemic infection persisted despite pulse generator explant and several years of appropriate antibiotic therapy. Without epicardial lead system removal, chronic pleuropericardial disease developed.