Implantation of an extravascular implantable cardioverter-defibrillator in a patient with retrosternal adhesions from epicardial leads implanted via a subxiphoid approach

Figures

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  Figure 1. Chronological outline of device history. Flowchart timeline outlining the patient’s congenital heart disease background and cardiac device history, illustrating the patient’s progression from epicardial pacemaker utilization in infancy to EV-ICD implantation in young adulthood. AV = atrioventricular; cCHB = congenital complete heart block; ccTGA = congenitally corrected transposition of the great arteries; CRT = cardiac resynchronization therapy; EV-ICD = extravascular implantable cardioverter-defibrillator; ICD = implantable cardioverter-defibrillator; RV = right ventricular; VF = ventricular fibrillation.

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  Figure 2. Pre-procedural computed tomography (CT) Scan. High, middle, and low slices from a preprocedural computed tomography scan, illustrating the course of abandoned epicardial leads, the presence and location of retrosternal adhesions, absence of the pericardium in the low retrosternal space, and close proximity of the coronary sinus, right atrial, and implantable cardioverter-defibrillator (ICD) leads. These findings informed risk assessment of management options and preprocedural planning for extravascular (EV)-ICD implantation. CS = coronary sinus; EV = extravascular; ICD = implantable cardioverter-defibrillator; RA = right atrial.

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  Figure 3. Postprocedural anteroposterior and lateral chest X-rays. Postprocedural anteroposterior and lateral chest X-rays demonstrating final positioning of EV-ICD lead relative to the abandoned epicardial pacing leads and other preexisting hardware. Findings also illustrate elements of previous risk assessment regarding extraction and replacement of the RV ICD lead. CS = coronary sinus; EV-ICD = extravascular implantable cardioverter-defibrillator; ICD = implantable cardioverter-defibrillator; RA = right atrial.