LAUSR

Inadequate connection between the lead and the Introduction Implantable cardioverter-defibrillators (ICDs) effectively prevent deaths resulting from ventricular tachyarrhythmias. Because of complications and lead failures associated with transvenous ICD systems, an entirely extravascular subcutaneous ICD (S-ICD) was developed. A large, multicenter, randomized trial suggested that the SICD was noninferior to traditional transvenous ICD systems with respect to delivering appropriate therapy, avoiding inappropriate therapy, and avoiding device-related complications, although the interpretation of these data has been questioned. The FDA issued a class I recall of the S-ICD lead Model 3501 on December 2, 2020 for an increased risk of lead fracture that could result in the inability to defibrillate ventricular arrhythmias and the potential for inappropriate shocks. Beyond the recalled lead, inappropriate shocks remain a concern for S-ICDs primarily due to oversensing T waves and myopotentials, or lead fracture, and have been reported to occur in 5%–13% of patients. header of the generator is a rare cause of electrical noise and inappropriate subcutaneous ICD therapy. This must be considered and carefully evaluated by removing, cleaning, and reinserting the lead into the header to evaluate for resolution of noise so that needless system extraction can be avoided. Case report A 42-year-old man with Brugada syndrome underwent implantation of an S-ICD in 2016 (lead model 3401). He had not experienced any shock or syncope since implantation. Owing to premature battery depletion, he presented for generator change, which was performed without acute