Key result
A 59-year-old man with an S-ICD experienced inappropriate shocks 10 months post-implant due to isolated generator displacement, which was diagnosed via lateral chest radiography.
Why the study?
S-ICD displacements may be less obvious than transvenous counterparts, and inappropriate device activity following lone generator displacement had not been described.
Case Report (n=1)
Isolated S-ICD generator displacement can cause inappropriate shocks, highlighting the need for careful inspection of lateral chest films.
May prompt closer S-ICD surveillance for occult displacement; leaves open optimal detection protocols in dilated cardiomyopathy.
Background: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are increasingly used in patients without a pacing indication, and may reduce venous complications, endocarditis and extraction morbidity. Subcutaneous implantable cardioverter-defibrillator displacements may be less obvious than their transvenous counterparts. Case summary: A 59-year-old man was found to have dilated cardiomyopathy associated with heavy alcohol intake following investigation for a stroke. Despite 2 years of alcohol cessation and optimal drug therapy, his ejection fraction remained severely impaired, and he received an S-ICD using the manufacturer recommended screening and implant method, and by an experienced operator. Ten months later, inappropriate shocks were delivered despite optimal programming. Device displacement was demonstrated by lateral chest radiography on the second instance of inappropriate therapy. On the first admission, a lateral film was not performed, and simple device programming was undertaken which failed to prevent the second occurrence. The patient requested an explant; as ventricular function had improved following initiation of sacubutril/valsartan, the clinical team opted to remove the device. Discussion: Careful inspection of lateral chest films and review of device indication are needed to reduce the risk of inappropriate shocks. This is the first description of inappropriate device activity following lone generator displacement-lead displacement is well described.
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Chow et al. (2023) conducted a case report in Dilated cardiomyopathy with S-ICD (n=1). Subcutaneous implantable cardioverter-defibrillator (S-ICD) was evaluated on Inappropriate shocks due to generator displacement. A 59-year-old man with an S-ICD experienced inappropriate shocks 10 months post-implant due to isolated generator displacement, which was diagnosed via lateral chest radiography.
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