Key result
Thoracoscopic guidance enables extravascular ICD implantation in a patient with prior sternotomy.
Why the study?
EV-ICD implantation with substernal leads is contraindicated in patients with prior sternotomy, limiting treatment options for ventricular arrhythmias in this population.
This report describes a novel technique for extravascular ICD implantation in a patient with prior sternotomy, a population for whom it is currently contraindicated.
May enable substernal EV-ICD after sternotomy; hypothesis-generating and requires prospective validation before adoption.
Extravascular implantable cardiac defibrillators (EV-ICDs) with substernal leads have become an attractive treatment option for ventricular arrhythmias.1 The system avoids a transvenous approach while providing anti-tachycardia pacing and defibrillation with a standard size pulse generator. EV-ICD implantation is currently contraindicated in patients with prior sternotomy.2
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Mao et al. (2026) studied this question. Thoracoscopic tunneling tool-assisted substernal extravascular ICD implantation was performed in a patient with prior sternotomy, despite this being a current contraindication.
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