Check that atrial lead!

Surprising. I think we all believe that lead infections requiring removal would be higher in the TV group. Group of really sick patients. Would like to see the comparison to dialysis patients who didn’t receive an ICD.

Yep. Was the LV ring conductor that was fractured. LV tip was fine. Changed pacing polarity with no issues (yet). Good ol St Jude Optum coated LV lead.

Didn’t do CXR (I don’t think we need to). See my reply to Andy Rudnick about what I did next. Generator change was in 2018.

So I brought the patient into the office and confirmed that the bipolar impedance was >3,000 ohms with no capture at maximal output (confirming a fracture). I then checked the LV tip to RV coil impedance (570 ohms) and the LV ring to RV coil impedance (>3,000 ohms). What is the issue? Next steps?

NYHA class I. EF normalized after CRT. Paced QRS duration with CRT is 140 msec.

Sudden increase in impedance. Did bring them into the office. No noise with pocket manipulation. Would you want to do anything else before discussing extraction and/or reimplantation of a new lead?

Nothing recently. The impedance is persistently >3,000.

Thanks Michael! So glad to be here.