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

Introduction A high-voltage (HV) electrical short circuit can be a critical electrical failure in an implantable cardioverter-defibrillator (ICD) system because of the failed delivery of appropriate shocks against fatal arrhythmia. The Food and Drug Administration has classified the St Jude Medical Riata family of ICD leads (St Jude Medical, St Paul, MN) as a class I recall since 2011 because of the “inside-out abrasion” problem. Currently, most of the externalized conductors are not related to an electrical malfunction. However, several reports have pointed out the risk of HV short circuit in Riata leads caused by the inside-out abrasion underneath the shocking coils. In the present report, we describe a case of successful rescue of an HV short circuit via the implementation of the automatic shocking-vector adjustment algorithm that secures HV shock delivery when an HV electrical short circuit is detected.