Key result
Off-label insertion of an extravascular implantable cardioverter defibrillator during coronary artery bypass surgery resulted in stable lead position and successful defibrillation testing at 12 weeks.
Why the study?
Implantation of defibrillators during cardiac surgery is rarely performed, but may be desirable when vascular approaches are lacking or to avoid the vascular space.
Case Report (n=1)
No
Demonstrates the feasibility of placing an extravascular ICD system during cardiac surgery to avoid the long-term risks associated with transvenous or subcutaneous systems.
May support concurrent extravascular ICD placement during CABG; hypothesis-generating and requires prospective validation before adoption.
Implantable defibrillators provide lifesaving therapy and are conventionally implanted via the transvenous or subcutaneous approach. Implantation of defibrillators during cardiac surgery is rarely performed but may be desirable because of lack of vascular approaches or a desire to avoid the vascular space. This approach has been achieved in epicardial systems using components of a transvenous implantable cardioverter defibrillator to create a “hybrid defibrillator.”
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Liu et al. (2025) conducted a case report in Resuscitated out-of-hospital cardiac arrest and multivessel coronary artery disease (n=1). Extravascular implantable cardioverter defibrillator (EV-ICD) was evaluated on Successful defibrillation testing and lead stability. Off-label insertion of an extravascular implantable cardioverter defibrillator during coronary artery bypass surgery resulted in stable lead position and successful defibrillation testing at 12 weeks.
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