This case report demonstrates that extravascular ICD (EV-ICD) implantation is a feasible and safe alternative to transvenous lead extraction and re-implantation in patients with complex venous anomalies like persistent left superior vena cava and a history of prior pericardial window.
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EV-ICD implantation feasible in PLSVC with prior pericardial window; leaves open broader safety/efficacy pending prospective data.
Transvenous implantable cardioverter-defibrillators (TV-ICDs) were developed to detect and correct life-threatening cardiac arrhythmias, significantly reducing the incidence of sudden cardiac death. However, despite their effectiveness, TV-ICD implantation carries notable risks, including cardiac perforation, vascular injury, and hemothorax (1). The development of subcutaneous implantable cardioverter-defibrillators (S-ICD) helped mitigate some of these risks. Nevertheless, due to their subcutaneous placement between the skin and sternum, S-ICDs require higher electrical energy to terminate arrhythmias, necessitating a larger impulse generator (2).
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Rimsky et al. (2025) studied this question.
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