What is the clinical evidence from this study?

Study design: Case Report. Population: Subcutaneous-to-extravascular implantable cardioverter-defibrillator exchange (n=1). Intervention: Single-pocket-incision generator exchange. Primary outcome: Feasibility of single-pocket-incision generator exchange.

What question did this study set out to answer?

This research aims to address the surgical challenges of exchanging subcutaneous to extravascular implantable cardioverter-defibrillators.

June 12, 2026Journal of Arrhythmia0 citationsOpen Access

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Single‐Pocket‐Incision Generator Exchange From a Subcutaneous to an Extravascular Implantable Cardioverter‐Defibrillator

YOYoshimi OnishiShowa University SCSaori ChinoShowa University MKMasaaki KurataShowa University Fujigaoka Hospital

Key Result

A single-pocket-incision approach with bidirectional dissection and separate deep-layer closure successfully enabled subcutaneous generator removal and extravascular pocket creation.

Key Points

This research aims to address the surgical challenges of exchanging subcutaneous to extravascular implantable cardioverter-defibrillators.
Fluoroscopic planning was conducted to identify adjacent generator sites.
Bidirectional dissection facilitated the removal and repositioning of the generator.
Separate deep-layer closure techniques were employed to maintain standard extravascular positioning.
The procedure was successfully performed using a single intervening pocket incision.
No significant complications were reported related to the incision or positioning of the new generator.
The new extravascular generator achieved desired placement without large continuous pocket issues.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A single case report describing a surgical technique for exchanging a subcutaneous to an extravascular implantable cardioverter-defibrillator.

Intervention

Single-pocket-incision generator exchange using bidirectional dissection and separate deep-layer closure

Outcome

Successful generator exchange and extravascular pocket creation

A single-pocket-incision approach is a feasible technique for exchanging a subcutaneous ICD for an extravascular ICD.

Abstract

Subcutaneous-to-extravascular implantable cardioverter-defibrillator exchange can create a practical challenge: the existing subcutaneous generator pocket lies posteriorly, whereas the new extravascular generator site is planned more anteriorly. In this case, fluoroscopic planning showed adjacent generator sites, allowing a single intervening pocket incision. Bidirectional dissection enabled subcutaneous generator removal and extravascular pocket creation, while separate deep-layer closure avoided a large continuous pocket and preserved standard extravascular generator positioning.

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Cite This Study

Onishi et al. (Mon,) conducted a case report in Subcutaneous-to-extravascular implantable cardioverter-defibrillator exchange (n=1). Single-pocket-incision generator exchange was evaluated on Feasibility of single-pocket-incision generator exchange. A single-pocket-incision approach with bidirectional dissection and separate deep-layer closure successfully enabled subcutaneous generator removal and extravascular pocket creation.

synapsesocial.com/papers/6a2bd11d6550ea4541ffe897 https://doi.org/https://doi.org/10.1002/joa3.70391