In high-risk patients with BS, primary prophylactic ICD therapy is an effective treatment. In this, young and otherwise healthy patient population, the IS rate is high.

No abstract

A 52-year-old male patient who previously received an implantable cardioverter defibrillator (ICD) because of Brugada syndrome in the left subcostal position, underwent battery replacement of the device in the same location. A few months later he attended the gastroenterological day clinic because of onset of severe constipation (3 months). Gastrointestinal check-up including colonoscopy was performed but no clear etiology was found. A few days later the patient came for a routine telemetric interrogation of his ICD. After a few unsuccessful attempts to interrogate the device it was decided to perform an abdominal X-ray (see Fig. 1). The pulse generator appeared having migrated to the pelvis from its original position. A chest X-ray was also performed, which showed the functioning lead was still correctly in place. We thus hypothesized that the constipation could be due to the ICD migration. Shortly after, the patient was admitted to the surgical division to undergo removal of the device from the intraabdominal space and its reimplantation in the previous subcostal position. After incision in the abdomen the battery was first searched for in the extraperitoneal space. This unsuccessful attempt led the surgeons to open the peritoneum. The device was finally found and appeared to have migrated to the Douglas cavity (an intraperitoneal recess situated anteriorly to the rectum and posteriorly to the bladder). The constipation resolved shortly after surgery. The most likely explanation of such an extensive migration could be due to the fact that the patient had recently started to perform intensive physical training (1 hour jogging per day), approximately 3-4 months before initiation of symptoms. The device probaFigure 1. Abdominal X-ray showing ICD generator migration to the pelvis.bly penetrated the intraperitoneal space because of accidental damage to the peritoneum while performing battery replacement in the subcostal position. This unique case shows that in the subgroup of patients with subcostal or abdominal ICD implantation too early and strenuous exercise can cause migration of the generator. Early recognition of this phenomenon is mandatory since it can lead to device malfunction.