Right-sided subcutaneous implantable cardioverter-defibrillator placement in a patient with dextrocardia, tetralogy of Fallot, and conduction disease

Patients with congenital heart disease may be ideal candidates for completely subcutaneous implantable cardioverter-defibrillator (S-ICD) systems because of the presence of intracardiac shunts, limited venous access, and intracardiac anatomy that may be contraindicated to transvenous implantable cardioverter-defibrillator (ICD) systems. However, even S-ICD systems may require nonstandard placement because of anatomic abnormalities in patients with complex congenital heart disease. We describe the placement of an S-ICD on the right side of the thorax in a patient with tetralogy of Fallot and dextrocardia and discuss the use of S-ICDs in the pediatric and adult congenital heart disease populations.