Early detection of lead fracture by painless high voltage lead impedance measurement in a transvenous ICD lead system

We report the case of a 69 year old patient, who underwent transvenous impl antable cardioverter defibrillator (ICD) device change (Medtronic GEM VR 72 27 Cx Active Can) because the ICD reached its replacement indicators. Preop erative chest X-ray and intraoperative defibrillation threshold tests and h igh voltage impedance did not show lead fracture of the five year old lead (Transvene 6936-68). At the second postoperative day the alarm of the newly implanted ICD device was activated because of high impedance in the painle ss lead impedance measurement (PLI) and the lead was replaced. The explante d lead showed a fracture detectable only by PLI.