Upgrade of ICD to CRT-D device complicated by infection, necessitating CRT-D system extraction and re-implantation – breachof duty, causation.

A male patient with cardiac sarcoidosis and an existing ICD with a normally functioning Medtronic Sprint-Fidelis ICD lead isupgraded to a CRT-D system and the Sprint-Fidelis lead extracted. Left ventricular lead displacement occurs requiring re-positioning, then lead erosion and infection, wound debridement and irrigation with ICD generator burial sub-pectorally before pocket infection, infection necessitating system extraction and re-implantation on the other side.