Key result
Sub-serratus generator repositioning improves PRAETORIAN score and achieves successful defibrillation at 65 J.
Why the study?
Subcutaneous ICD efficacy depends on extracardiac shock vector geometry, which can undergo late deterioration after substantial weight gain.
Case Report (n=1)
S-ICD geometry should be considered dynamic after major changes in body habitus, and sub-serratus generator repositioning can successfully salvage obesity-driven geometric failure when lead mobilization is precluded by fibrosis.
May prompt impedance surveillance after weight gain in S-ICD patients; hypothesis-generating for generator repositioning.
S-ICD efficacy depends on extracardiac shock vector geometry. We report late obesity-associated geometric deterioration after substantial weight gain. Rising shock impedance prompted reassessment at generator replacement, revealing pocket dehiscence, adipose interposition, and generator superficialization. Because fibrosis precluded parasternal lead mobilization by simple traction, sub-serratus generator repositioning improved the PRAETORIAN score and shock impedance. Despite a subsequent rise to 130 Ω, defibrillation succeeded with a 65 J shock. S-ICD geometry should be considered dynamic, particularly after major changes in body habitus.
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Turreni et al. (2026) conducted a case report in Late obesity-associated subcutaneous ICD (S-ICD) geometric failure (n=1). Sub-serratus generator repositioning was evaluated on PRAETORIAN score, shock impedance, and defibrillation success. Sub-serratus generator repositioning improved PRAETORIAN score and achieved successful defibrillation at 65 J despite shock impedance rising to 130 Ω.
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