Treatment Strategy for Fatal Arrhythmias in Ebstein’s Anomaly Combined With Leadless Pacemaker and S-ICD Implantations

Combining Leadless Pacemaker With a Subcutaneous Implantable Cardioverter-Defibrillator

“…Transvenous lead implantation has been shown to be feasible with direct puncture from the pulmonary artery to the atria, but this increases the risk of thromboembolic events. 15 Patients with Ebstein’s anomaly who have their superior vena cava connected to the pulmonary artery, like in the case described by Takami et al, 13 also fall in the same category. However, this group still maintains access to the heart through the inferior vena cava, which makes LP implantation feasible.…”

“…In conclusion, the 2 contributions published in this issue of the JACC: Case Reports support a role for the combined implantation of an S-ICD and an LP in patients who are not good candidates for conventional transvenous leads. 10 , 13 The procedural workflow described in these reports was associated with excellent acute and short-term postprocedural outcomes. (Follow-up ranged from 3 to 18 months.)…”

“…In a separate contribution, Takami et al 13 describe the successful combined use of an S-ICD and LP in a patient with Ebstein’s anomaly, prior tricuspid valve replacement, and bidirectional Glenn surgical repair. This report is of clinical interest in light of the limited vascular access options frequently encountered in CHD patients.…”