What question did this study set out to answer?

To evaluate the implications of implanting an extravascular defibrillator alongside a pre-existing endocardial dual-chamber defibrillator.

January 10, 2026HeartRhythm Case Reports0 citationsOpen Access

Implantation of an extravascular defibrillator with a pre-existing endocardial dual-chamber defibrillator: when two defibrillators share one heart

MEMathieu EchivardCentre Hospitalier Régional et Universitaire de Nancy HPHugo Pegorer-SfesCentre Hospitalier Régional et Universitaire de Nancy LFLuc FreyszCentre Hospitalier Régional et Universitaire de Nancy

Key Points

To evaluate the implications of implanting an extravascular defibrillator alongside a pre-existing endocardial dual-chamber defibrillator.
performed a dual implantation procedure

Structured PICO

Is it feasible and safe to implant an extravascular ICD in a patient with a pre-existing endocardial dual-chamber ICD?

Population

1 71-year-old man with ischemic cardiomyopathy, severe left ventricular dysfunction (LVEF 25%), history of ventricular tachycardia, sinus node dysfunction, and multiple ICD system revisions, presenting after an inappropriate ICD shock due to right ventricular lead fracture.

Intervention

Extravascular implantable cardioverter-defibrillator (EV-ICD) implantation alongside a pre-existing endocardial dual-chamber ICD system.

Outcome

Feasibility, safety, and absence of device-device interaction.safety

Implantation of an extravascular ICD in a patient with a pre-existing endocardial dual-chamber ICD is feasible and safe, providing a novel off-label approach for patients with complex venous anatomy or high procedural risk for lead extraction.

Abstract

Implantable cardioverter-defibrillators (ICDs) are a cornerstone therapy for the prevention of life-threatening ventricular arrhythmias(1). However, transvenous ICD systems carry long-term risks such as infection, lead failure, and venous thrombosis—particularly concerning in younger patients who may require lifelong device therapy.

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