Recently, polarity-dependent shock failures were reported in implantable cardioverter-defibrillators caused by structural failure in the high-voltage feedthrough. Short circuits may occur when the right ventricular coil is cathodal for phase 1 of biphasic shocks (cathodal shock). This viewpoint proposes a mechanism for observed polarity dependence and considers whether the same mechanism may apply in other shock-induced, short circuits. Implantable cardioverter-defibrillator connections to the lead traverse feedthroughs into the hermetically sealed housing (\"Can\"). The feedthrough comprises 2 concentric, conducting metal cylinders, the inner pin-conductor to the right ventricular coil and outer Can, separated by impermeable insulation. Shock failure depends on 3 conditions: 1) development of a fluid layer in the feedthrough, creating a conduction path in parallel with the shock pathway; 2) the radial gradient of the electric field in the fluid, so resistive heating during a shock vaporizes water to form a high-resistance gas bubble around the pin; and 3) field emission of electrons at the cathode, with rate and energy dependent on the field\'s strength and the cathode\'s potential-energy barrier to emission. For cathodal shocks, electrons emitted at the metal pin may initiate an ionization avalanche in the gas until it \"breaks down\" into a low-resistance plasma, resulting in a short circuit. For anodal shocks, the effective cathode is the liquid-gas interface, where the field is weaker than at the pin. Additionally, solvated electrons in aqueous solution must overcome a higher potential-energy barrier to be emitted. This permits the high-resistance gas bubble to stabilize so that the shock is completed.

BACKGROUND: In 2022 and 2023, Medtronic recalled implantable defibrillators because they may deliver less than full-energy shocks. The 2022 problem truncates the second phase of the waveform (SCP-T2), resulting in ∼32-J shocks, and is mitigated by downloadable software. The 2023 malfunction truncates the first phase of the waveform, resulting in 0- to 12-J shocks due to a glassed feedthrough problem (GFT-T1) that might be avoided by programming B>AX shock polarity.
OBJECTIVE: The purpose of this study was to assess the consequences of GFT-T1 and SCP-T2 shocks in the Food and Drug Administration\'s Manufacturers and User Facility Device Experience (MAUDE) database and to estimate the incidences of GFT-T1 and SCP-T2.
METHODS: We analyzed MAUDE reports supplemented by Medtronic data; lead failures were excluded. The incidences of SCP-T2 and GFT-T1 were estimated using USA volumes for devices with glassed feedthroughs.
RESULTS: One hundred thirty-two devices delivered truncated shocks: 27 (20.5%) were GFT-T1; 103 (78.0%) were SCP-T2; and 2 (1.5%) truncated both phases (BOTH-T1&2). Of 54 ventricular fibrillation (VF) patients, 21 (38.9%) were not defibrillated by truncated shocks: 8 (38.1%) received GFT-T1 shocks, 12 (57.1%) received SCP-T2 shocks, and 1 received a BOTH-T1&2 shock; 2 patients suffered unrelated deaths; 1 was externally rescued; 1 outcome was unknown; the others were defibrillated by subsequent shocks or terminated spontaneously. The majority of patients (79.1%) shocked for ventricular tachycardia (VT) were converted, primarily (94.1%) by SCP-T2 shocks. Estimated incidences of GFT-T1 and SCP-T2 were 0.0078%-0.0088% and 0.1062%-0.1110%.
CONCLUSIONS: GFT-T1 and SCP-T2 shocks can result in failure to terminate VF/VT, but they may be preventable. Although the incidences of these truncated shocks are very low, heightened surveillance is warranted.

A systematic microstructural characterization of alumina joined to Hastelloy C22® by means of a commercial active TiZrCuNi alloy, named BTi-5, as a filler metal is reviewed and discussed. The contact angles of the liquid BTi-5 alloy measured at 900°C for the two materials to be joined are 12° and 47° for alumina and Hastelloy C22® after 5 min, respectively, thus demonstrating good wetting and adhesion at 900 °C with very little interfacial reactivity or interdiffusion. The thermomechanical stresses caused by the difference in the coefficient of thermal expansion (CTE) between the Hastelloy C22® superalloy (≈15.3 × 10-6 K-1) and its alumina counterpart (≈8 × 10-6 K-1) were the key issues that had to be resolved to avoid failure in this joint. In this work, a circular configuration of the Hastelloy C22®/alumina joint was specifically designed to produce a feedthrough for sodium-based liquid metal batteries operating at high temperatures (up to 600 °C). In this configuration, adhesion between the metal and ceramic components was enhanced after cooling by compressive forces created on the joined area due to the difference in CTE between the two materials.

As one of the core components of MEMS (i.e., micro-electro-mechanical systems), thin-film piezoelectric-on-silicon (TPoS) resonators experienced a blooming development in the past decades due to unique features such as a remarkable capability of integration for attractive applications of system-on-chip integrated timing references. However, the parasitic capacitive feedthrough poses a great challenge to electrical detection of resonance in a microscale silicon-based mechanical resonator. Herein, a fully-differential configuration of a TPoS MEMS resonator based on a novel structural design of dual interdigital electrodes is proposed to eliminate the negative effect of feedthrough. The fundamental principle of feedthrough suppression was comprehensively investigated by using FEA (i.e., finite-element analysis) modeling and electrical measurements of fabricated devices. It was shown that with the help of fully-differential configuration, the key parameter of SBR (i.e., signal-to-background ratio) was significantly enhanced by greatly suppressing the in-phase signal. The S-parameter measurement results further verified the effectiveness of this novel feedthrough suppression strategy, and the insertion loss and SBR of proposed TPoS resonators were improved to 4.27 dB and 42.47 dB, respectively.