Extravascular ICD implantation is presented as a potential solution for a teenager with Brugada syndrome experiencing inappropriate shocks from a subcutaneous ICD.
Brugada syndrome (BrS) is an inherited cardiac ion-channel disorder characterized by a coved-type ST-segment elevation in the right precordial leads and a propensity for malignant ventricular arrhythmias1. In young patients who require lifelong arrhythmic protection, transvenous implantable cardioverter-defibrillator (ICD) systems prevent sudden death but expose them to lead-related infection, fracture, and vascular obstruction1. The subcutaneous ICD (S-ICD) eliminates intravascular hardware, yet its far-field sensing architecture is vulnerable to T-wave oversensing and consequent inappropriate shocks, pitfalls that are accentuated in lean, physically active adolescents with BrS, whose repolarization morphology is highly dynamic.
Garibaldi et al. (Fri,) studied this question.