BackgroundThis abstract illustrates the first time that a lead alert triggered in an implantable cardioverter-defibrillator (ICD) detected acute hyperkalemia.MethodsA 65 year old male presented after hearing audible alerts from his Medtronic Maximo VR® with a Sprint-Fidelis® 6949 lead (Medtronic Inc., Minneapolis MN). The Lead Integrity Alert (LIA)® intended to provide early warning of lead fracture, had been triggered when the impedance on his SVC coil reached above 100 ohms and was 118 on presentation. His usual SVC lead impedance had been 74 ohms. Along with the SVC coil impedance, the ventricular pacing impedance and the defibrillation impedance had also increased. However, his laboratory values on admission were unexpected with hyperkalemia (K+ 8.2 mmol/L) and acute renal failure (Creatinine 4.4 mg/dL, GFR 13 mL/min), along with ECG changes of hyperkalemia. His metabolic derangement was explained by changes in medication recently. His electrolytes and renal function quickly improved back to baseline with a few days of supportive treatment and surprisingly, his lead impedances also trended back to his baseline values as his potassium levels normalized. Figure 1 shows the SVC coil impedances correlating with potassium.A few weeks later another a patient was admitted with volume depletion, hyperkalemia, and acute renal failure. Interestingly the SVC impedances seemed to correlate with the serum potassium changes for this patient also.ResultsThe SVC impedance was found to detect changes in impedance of cardiac tissue with potassium changes.ConclusionAs devices and leads become more sophisticated, their role for monitoring parameters and triggering alerts may expand to include electrolyte and other metabolic changes. BackgroundThis abstract illustrates the first time that a lead alert triggered in an implantable cardioverter-defibrillator (ICD) detected acute hyperkalemia. This abstract illustrates the first time that a lead alert triggered in an implantable cardioverter-defibrillator (ICD) detected acute hyperkalemia. MethodsA 65 year old male presented after hearing audible alerts from his Medtronic Maximo VR® with a Sprint-Fidelis® 6949 lead (Medtronic Inc., Minneapolis MN). The Lead Integrity Alert (LIA)® intended to provide early warning of lead fracture, had been triggered when the impedance on his SVC coil reached above 100 ohms and was 118 on presentation. His usual SVC lead impedance had been 74 ohms. Along with the SVC coil impedance, the ventricular pacing impedance and the defibrillation impedance had also increased. However, his laboratory values on admission were unexpected with hyperkalemia (K+ 8.2 mmol/L) and acute renal failure (Creatinine 4.4 mg/dL, GFR 13 mL/min), along with ECG changes of hyperkalemia. His metabolic derangement was explained by changes in medication recently. His electrolytes and renal function quickly improved back to baseline with a few days of supportive treatment and surprisingly, his lead impedances also trended back to his baseline values as his potassium levels normalized. Figure 1 shows the SVC coil impedances correlating with potassium.A few weeks later another a patient was admitted with volume depletion, hyperkalemia, and acute renal failure. Interestingly the SVC impedances seemed to correlate with the serum potassium changes for this patient also. A 65 year old male presented after hearing audible alerts from his Medtronic Maximo VR® with a Sprint-Fidelis® 6949 lead (Medtronic Inc., Minneapolis MN). The Lead Integrity Alert (LIA)® intended to provide early warning of lead fracture, had been triggered when the impedance on his SVC coil reached above 100 ohms and was 118 on presentation. His usual SVC lead impedance had been 74 ohms. Along with the SVC coil impedance, the ventricular pacing impedance and the defibrillation impedance had also increased. However, his laboratory values on admission were unexpected with hyperkalemia (K+ 8.2 mmol/L) and acute renal failure (Creatinine 4.4 mg/dL, GFR 13 mL/min), along with ECG changes of hyperkalemia. His metabolic derangement was explained by changes in medication recently. His electrolytes and renal function quickly improved back to baseline with a few days of supportive treatment and surprisingly, his lead impedances also trended back to his baseline values as his potassium levels normalized. Figure 1 shows the SVC coil impedances correlating with potassium. A few weeks later another a patient was admitted with volume depletion, hyperkalemia, and acute renal failure. Interestingly the SVC impedances seemed to correlate with the serum potassium changes for this patient also. ResultsThe SVC impedance was found to detect changes in impedance of cardiac tissue with potassium changes. The SVC impedance was found to detect changes in impedance of cardiac tissue with potassium changes. ConclusionAs devices and leads become more sophisticated, their role for monitoring parameters and triggering alerts may expand to include electrolyte and other metabolic changes. As devices and leads become more sophisticated, their role for monitoring parameters and triggering alerts may expand to include electrolyte and other metabolic changes.