Key result
Sub-generator fat emerges as a potential risk factor for high EV-ICD defibrillation thresholds.
Why the study?
Although defibrillation threshold testing is typically recommended for extravascular ICDs, the factors associated with high defibrillation threshold remain unclear.
Does sub-generator fat increase the risk of high defibrillation threshold in patients with an extravascular implantable cardioverter-defibrillator?
Case Report
Does sub-generator fat increase the risk of high defibrillation threshold in patients with an extravascular implantable cardioverter-defibrillator?
Sub-generator fat may be a risk factor for high defibrillation threshold in extravascular ICDs, similar to what is observed in subcutaneous ICDs.
Implantable cardioverter-defibrillators (ICDs) effectively prevent sudden cardiac death(1). The extravascular ICD (EV-ICD) is a novel system that avoids transvenous leads by placing a single lead in the substernal space(2,3). Although defibrillation threshold (DFT) testing is typically recommended for EV-ICDs, the factors associated with high DFT remain unclear. In subcutaneous ICDs (S-ICDs), sub-coil and sub-generator fat have been reported as predictors of high DFT, likely due to attenuation of the shock vector(4).
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Oshima et al. (2026) conducted a case report in High defibrillation threshold in extravascular implantable cardioverter-defibrillator. Sub-generator fat was evaluated on High defibrillation threshold. Sub-generator fat is presented as a potential risk factor for high defibrillation threshold in an extravascular implantable cardioverter-defibrillator.
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