Successful Implantable Cardioverter Defibrillator Placement in an Ambulatory Patient Without Thoracic Venous Access

n=1 ambulatory patient requiring permanent cardiac pacing and implantable cardioverter defibrillator (ICD) function, with no suitable thoracic vascular access, who refused cardiac surgery.

Left femoral venous approach to introduce two extended-length, active fixation leads positioned in the right atrium and ventricle, tunneled to the abdomen and connected to a dual-chamber ICD.

Defibrillation threshold, pacing, and sensing parameters at implant and 6-month follow-up.surrogate