Successful intermuscular implantation of subcutaneous implantable cardioverter defibrillator in a Japanese patient with pectus excavatum

Abstract

The entirely subcutaneous implantable cardioverter-defibrillator (ICD) system was developed to provide a life-saving defibrillation therapy that does not affect the heart and vasculature. The subcutaneous ICD is preferred over the transvenous ICD for patients with a history of recurrent infection presenting major life-threatening rhythms. In this case report, we describe the first successful intermuscular implantation of a completely subcutaneous ICD in a Japanese patient with pectus excavatum. There were no associated complications with the device implantation or lead positioning. Further, the defibrillation threshold testing did not pose any problem with the abnormal anatomy of the patient.

Successful implantation of S‐ICD using the intermuscular two‐incision technique in a patient with severe pectus excavatum

“…Implantation of S‐ICD in patients with pectus excavutum is a challenging procedure due to the anatomical alterations of the structures that require adequate positioning of the defibrillation catheter to obtain satisfactory signal detection and defibrillation margin. In literature, there are isolated experiences describing the feasibility of this challenging procedure 6‐8 . In this report, we describe the case of a patient with severe pectus excavatum, in which the S‐ICD implantation procedure was accomplished by means of the intermuscular two‐incision technique with ultrasound‐guided nerve block to provide anesthesia/analgesia.…”

“…In literature, there are isolated experiences describing the feasibility of this challenging procedure. 6 , 7 , 8 In this report, we describe the case of a patient with severe pectus excavatum, in which the S‐ICD implantation procedure was accomplished by means of the intermuscular two‐incision technique with ultrasound‐guided nerve block to provide anesthesia/analgesia.…”

Combination of a leadless pacemaker and subcutaneous implantable cardioverter defibrillator therapy for a Japanese patient with prosthetic valve endocarditis

“…Entirely subcutaneous implantable cardioverter defibrillators (S-ICD™; Boston Scientific Corp., Marlborough, MA, USA) provide effective defibrillation and reduce the risk of infection or lead problems. [1][2][3] However, as patients with bradycardia pacing indications are excluded from S-ICD therapy because the device lacks the capability for defibrillation in this patient group, they are used less than transvenous implantable cardioverter defibrillators (ICDs). Leadless pacemaker (LP) systems have recently been developed, and their combined use with S-ICD provides a potential solution to the problem with S-ICD use without transvenous leads for patients with an ICD together with pacing indications.…”