Implantation of a fully subcutaneous ICD in a patient with single ventricle morphology and Eisenmenger physiology

Abstract

Implantable cardioverter-defibrillator (ICD) therapy has been adopted increasingly in congenital heart disease. However, in patients with intracardiac right-to-left shunting the use of standard transvenous ICD lead systems is relatively contraindicated due to the increased risk of systemic thromboembolism. In this constellation, a recently introduced totally subcutaneous ICD system (S-ICD) seems to be a good and minimal invasive alternative to conventional epicardial ICD therapy. Here we describe the first use of this S-ICD in a patient with single ventricle and Eisenmenger physiology. In this unusual cardiac anatomy modification of the standard implantation technique by use of short sequences of fluoroscopy helped to ensure exact electrode and can placement and thus regular function of the S-ICD system.

Right-sided subcutaneous implantable cardioverter-defibrillator placement in a patient with dextrocardia, tetralogy of Fallot, and conduction disease

“…The S-ICD system typically is placed in the left axilla, with the subcutaneous coil positioned to the left of the sternum 6 . There are currently few reports in the literature on use of an S-ICD system in nonstandard positions 7, 8, 9, 10, 11. In our patient, the S-ICD system functioned appropriately and effectively with positioning of the generator in the right axilla and the subcutaneous coil on the right side of the chest.…”

Clinical Experience With the Subcutaneous Implantable Cardioverter–Defibrillator in Adults With Congenital Heart Disease

“…Previous experience with this technology has generally been limited to case reports and small series that describe the feasibility of implantation with limited follow-up. 8,13 Recently, a pooled analysis from the combined EFFORTLESS and IDE postmarket studies containing a modest number of adult patients with congenital heart disease (n=16) was published. 14 The results of this registry suggested reasonable sensing discrimination, but the study was limited by a lack of detail regarding surgical palliation and an absence of tachyarrhythmia events during by guest on May 11, 2018 http://circep.ahajournals.org/ Downloaded from S-ICD in Congenital Heart Disease follow up.…”

“…[5][6][7] The S-ICD has been advocated as a means of circumventing many of these limitations and, therefore, may be ideally suited to the ACHD population. [8][9][10][11] Although there are emerging data regarding eligibility for the S-ICD among patients with ACHD, 9,12 there is little clinical experience with this technology. Knowledge of the forms of congenital heart disease most likely to benefit, reasons for device placement, and clinical performance are needed.…”

Complete right bundle branch block and QRS-T discordance can be the initial clue to detect S-ICD ineligibility

“…However, compared to western countries, the implantation of ICD for patients with ischemic heart disease is much less in Japan [17]. Additionally, considering the risks and benefits of an S-ICD, the most appropriate diseases for S-ICD are congenital heart diseases because sometimes there is no venous access for ICD [18]. Patients with Brugada syndrome and idiopathic ventricular arrhythmia (IVF) also appeared to be appropriate for S-ICD because most of them had a normal LVEF and did not need ventricular pacing.…”