Hybrid subcutaneous and transvenous approach for cardiac resynchronization defibrillator implant in a patient with congenital heart disease and tricuspid bioprosthetic

His-Optimized Cardiac Resynchronization Therapy (HOT-CRT) in a subcutaneous ICD patient: first-in-human case report

“…In one case, a completely leadless CRT-D system was created by using an LP (Medtronic Micra TPS) combined with a WiSE-CRT system (EBR Systems, Sunnyvale, CA) and an s-ICD 16 . When conventional ICD lead implantation has proved impossible, other strategies have been adopted, such as the use of a hybrid subcutaneous and trans-venous CRT-D approach using the Medtronic 6996SQ Finger subcutaneous array lead 17 , and ICD lead implantation in the coronary sinus in the context of CRT-D 18 . In one case, an s-ICD with a right parasternal electrode plus an AAI PPM was implanted 19 , and in another case, owing to multiple ventricular lead fractures causing inappropriate shocks, an s-ICD was implanted and the existing TV-ICD was reprogrammed as an AAI pacemaker 20 .…”