Externalized conductors and insulation failure in Biotronik defibrillator leads: History repeating or a false alarm?

Figure 1 Cross-section design of a modern implantable cardioverter-defibrillator lead. ETFE: Ethylenetetrafluoroethylene.

Figure 2 A typical transvenous implantable cardioverter-defibrillator lead with DF-1 connection and dual-coil design. SVC: Superior vena cava.

Figure 3 Overview of Kentrox and Linox Biotronik leads. Courtesy of Biotronik Italia.

Figure 4 Intracardiac electrogram recording of nonphysiological sensed events due to insulation failure in the patient managed in our center. NSO: Non sustained oversensing; AS: Atrial sensing; VS: Ventricular sensing.

Figure 5 Fluoroscopy image of Kentrox conductor externalization just proximal to the ventricular coil in the patient managed in our center.