High-Frequent and Spontaneously Diminishing Noises after Shock: A Case of Rare Trouble in Replacement of Implantable Cardioverter-Defibrillator

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A 54-year-old male patient, who had received implantable cardioverter-defibrillator (ICD) for Brugada syndrome in 2002, visited our clinic for alert sound in March 2011. The stored electrocardiogram revealed short and high-frequent noises. Since lead dysfunction was diagnosed, we replaced the ICD system. When we tested ICD shock delivery to evaluate defibrillation threshold (DFT) after the replacement, high-frequent noises were observed intermittently for 10 seconds just after 26 J shock. We repeated shock test one week later and again observed the high-frequent noises intermittently for 110 seconds after 26 J shock. Some of the noises were recognized by ICD inappropriately as ventricular fibrillation. Strangely enough, the amplitude of the noises spontaneously diminished and disappeared. We suspected a kind of ICD system dysfunction and decided to replace the system again. In operation, we found a small amount of blood in the connector of ICD, which might be a result of blood leak through the hole for wrench. Since then, no noise occurred. To our knowledge, this is the first report such strange noises associated with blood contamination in lead-ICD connection.