One Indication for an Extravascular Cardiac Resynchronization Therapy Defibrillator: Lessons from a Combination Therapy Case with Epicardial Cardiac Resynchronization Therapy and a Subcutaneous Implantable Cardioverter Defibrillator

Abstract

Extravascular cardiac resynchronization therapy (CRT) defibrillators (CRT-Ds) are ideal for recurrent blood stream infections. Furthermore, CRT is useful for patients intolerant to right ventricular (RV) pacing. The case was a 65-year-old man with a CRT-D who presented with a blood stream infection. Because he was hemodynamically unstable with temporary RV pacing, an epicardial CRT device was re-implanted concomitantly through a surgical procedure. After the operation, a subcutaneous implantable cardioverter defibrillator (S-ICD) was placed. However, not all pacing is eligible for S-ICD screening. Combination therapy with an epicardial CRT device and S-ICD might be an alternate option for cardiac surgery cases.

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

“…Many cases of the concomitant use of s-ICD and TV-PPM 9,10 , epicardial PPM 11 , epicardial CRT-P 12 , and HBP devices 13 have been reported. In addition, there are numerous case-reports of the associated use of leadless PPM (LP) and s-ICD 14 .…”

S-ICD Implantation "Tips and Tricks"

“…Some pacing sites and modalities (septal right ventricle pacing, biventricular pacing, His-bundle pacing) may produce more S-ICD eligible QRS morphologies than others (apical right ventricle pacing) [ 128 , 129 , 130 , 131 ]. Epicardial pacing systems, both conventional [ 36 , 132 ] and resynchronization therapy ones [ 133 ], were also successfully co-implanted with S-ICDs. In all of the above situations, the decision to add an S-ICD to a pacemaker may be made after positive screening.…”