Subcutaneous implanted cardioverter-defibrillator in ventricular noncompaction, coronary artery disease and stroke

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Left ventricular hypertrabeculation/noncompaction (LVHT) is a congenital heart condition associated with an increased risk of arrhythmias and sudden cardiac death.
• Current guidelines recommend implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death in eligible LVHT patients.
• Transvenous ICD leads carry risks, including right ventricular perforation, a particular concern in patients with cardiac abnormalities.

Observation:

• A patient with LVHT, arterial hypertension, hyperlipidemia, coronary artery disease, and a history of myocardial infarction and stroke presented with a persistently low ejection fraction (33%).
• Despite optimal medical therapy including bisoprolol, sacubitril/valsartan, and spironolactone, the patient's ejection fraction did not improve.
• The patient had no indication for pacing therapy, making them a potential candidate for alternative ICD systems.

Findings:

• The patient was treated with a subcutaneous implantable cardioverter-defibrillator (S-ICD) for primary prevention of sudden cardiac death.
• The S-ICD system was chosen to mitigate the risks associated with transvenous ICD leads, such as right ventricular perforation.
• This case highlights the successful application of S-ICD in a complex LVHT patient profile.

Implications:

• Subcutaneous ICDs represent a viable alternative for primary sudden cardiac death prevention in LVHT patients who do not require pacing.
• Utilizing S-ICD may reduce the risk of lead-related complications in this specific patient population.
• Further research into the long-term efficacy and safety of S-ICDs in LVHT patients is warranted.