The official ESC journal Europace publishes an online case report by Dr. Martin Hudec about the extremely rare and spectacular failure of a recently implanted Biotronik 340 VR-T ICD in a 46-year-old man. The battery of the device apparently overheated, causing the device to malfunction and leading to severe internal burning.

On Wednesday, October 6, US electrophysiologist Westby Fisher summarizes the Europace article on his blog and reprints several extremely gruesome pictures taken from the case report.

At 9:22 PM CST Fisher updates his blog with the information that the case report is no longer available on the Europace website. The Europace website contains no explanation for the withdrawal/retraction.

On Thursday morning Fisher removes his earlier post and adds a new post, Defensive Blogging, explaining his reasons for removing the post. Fisher writes that he’s written to Europace editor John Camm asking about the disappearance of the article.

The story continues in the comments section. Fisher posts a letter he received from Hudec, the author of the case report, who goes on at great length about his decision to withdraw the case report “voluntarily” after he “received new important information.” However, the only important information he shares with Fisher is that he is concerned about “some kind of media sensation being created without the facts.”

Hudec also takes issue with the word “explosion” and says that engineers prefer the term “venting.”

The term “explosion” is not accurate. After talking to engineers the more appropriate word would be ‘venting’ of the battery. The shape of ICD was distorted, but not ruptured in any way.

Hudec further tells Fisher that “Professor Camm and I have discussed this situation, and he fully supports the conclusion that the inaccuracies in the case report require the withdrawal.” With the possible exception of the use of the word “explosion” it is hard to know to what inaccuracies Hudac is referring. The real problem seems to be this:

This was a singular event, and I do not agree that all the negative discussion around these devices is appropriate.

On Friday evening, Westby Fisher, the electrophysiologist and blogger who first drew attention to the Europace report, met with officials from Biotronik and later summarized the meeting on his blog.

The Biotronik officials shed some additional light– and perhaps raised some additional questions– on the episode. With the permission of the company Fisher reprints a PDF of the internal Biotronik memo that appears to provide the fullest chronology of the episode so far.

The memo establishes a number of  significant facts:

• The episode occurred on May 12, 2010 in the Slovak Republic and was reported to the FDA on May 19. An update with the company’s analysis of the episode was submitted to the FDA on June 7, 2010.
• The company believes this to be a “singular event” that won’t results in a recall and that the company will not i
• This is the first time an event like this has occurred in a Biotronik device, but “sudden discharges of battery energy, commonly referred to as “hot pocket” have previously (but rarely) been reported in the CRM industry,” the memo states.

The company is less helpful in its explanation for the withdrawal of the Europace article. Here is what the memo states:

Why was the case report withdrawn?

The author reported that after submitting the case report to Europace in June, further analysis was conducted but not included in the original report. As such, there are inaccuracies that need to be corrected. Specifically, the author stated that the term “explosion” was not accurate given that the device was distorted, but had not exploded as previously described. The author also observed that while this is the first such incident with a BIOTRONIK device, it is not in fact the first experience of a battery overheating in the industry.

When was the case report withdrawn from Europace online?

The case report was voluntarily withdrawn by the physician-author, Dr Martin Hudec, on October 5, 2010. On October 6, 2010, the case report was removed from the Europace website.

Although Biotronik has an obvious and legitimate interest in the publication of the case report, the company’s role in the publication (or depublication) process appears questionable. The two “inaccuracies” noted in the memo– the use of the word “explosion” and the fact that batteries in other devices have overheated in the past– don’t seem to warrant withdrawal of the publication from an independent, academic journal without any explanation or notification from the editor. Wouldn’t a brief correction have sufficed? One can certainly see how from a public relations point of view the disappearance of the article would be of value to Biotronik.

It is less clear how the withdrawal serves the editorial purpose of an academic journal like Europace.

Larry Husten is a writer and editor of CardioBrief.org.

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