A 28-year-old female with long-QT syndrome had received an implantable cardioverter-defibrillator (ICD) 4 years and 6 months earlier for secondary prevention of sudden cardiac death. She presented with apparent dual-lead failure (sudden increase in pacing impedance and threshold of atrial and ventricular leads) after backpacking (∼30 kg) for several months.
On intra-operative visual inspection both leads appeared intact and they showed normal values with an external analyser. However, the header of the ICD was loose, deviated, and separated from the can which was presumed to be due to physical stress to the junction between the header and the can. The device was replaced and the lead measurements were normal thereafter. Thus, this case emphasizes that leads are not always the culprit.
Conflict of interest: C. K. has received lecture fees from Biotronik, Boston, Medtronic, Sorin, and St Jude Medical and is or was an advisor to Biotronik, Sorin and St Jude Medical.
Funding
H.B. and H.V. are supported by a training fellowship provided by the European Heart Rhythm Association.
