First Reported Extravascular-ICD Insertion in a Patient With Prior Sternotomy for Valvular Surgery

Figures

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  Figure 1. Preprocedural Computed Tomography Scan Assessment of the retrosternal space and localization of the sternal wires. The retrosternal space is measurable, with a minimal distance between the heart and sternum of approximately 5 mm. No adhesion of the heart to the sternum is observed. There is only minimal replacement of fat by fibrosis.

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  Figure 2. Substernal Tunneling With Injection of Iodinated Contrast Medium Location of the sheath is typical in both views. No abnormal opacification of the pericardium, pleura, or heart is observed after injection. (A) Anteroposterior view (0°). (B) Left anterior oblique view (90°).

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  Figure 3. Anteroposterior Chest X-Ray Post-Insertion Positioning of the lead and the generator is conventional on the postoperative x-ray film. The lead is distant from the sternotomy wires on this view. No complications are observed.

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  Figure 4. Remote Monitoring Follow-Up at 8 Weeks Post-Insertion Remote monitoring tracing at 8 weeks post-Insertion demonstrates no lead noise, with absent or minimally visible P waves (P/R ratio <1/10).

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  Visual Summary. Clinical Context, Preprocedural Imaging, Procedural Workflow, and Postoperative Follow-Up of Extravascular ICD Insertion in a Patient with Prior Median Sternotomy CT = computed tomography; EV-ICD = extravascular implantable cardioverter defibrillator; ICD = implantable cardioverter defibrillator; S-ICD = subcutaneous implantable cardioverter defibrillator.