Implantation and Follow-Up of an Extravascular ICD After a Challenging Transvenous System Extraction: A Case Report

The Extravascular ICD (EV-ICD) is implanted outside of the patient's heart and vascular system. The defibrillation lead is tunneled in the substernal space, very close to the surface of the heart, thus allowing for additional pacing capabilities such as Post Shock Pacing, Anti-Tachycardia Pacing (ATP), and Pause Prevention Pacing. Early studies demonstrated the safety and efficacy profile of the EV-ICD, but patients with previous or existing cardiac devices or leads were excluded. In this case report we describe the implantation of an EV-ICD in a 68-year-old male patient, who had undergone a challenging extraction of a previous transvenous system due to infection and screened negative for a subcutaneous ICD (S-ICD). Given the lack of upper and lower venous accesses, it was also necessary to implant an epicardial bipolar lead connected to a single-chamber pacemaker as a backup during extraction, which also remained in place chronically. Follow-up was uneventful through the following 10 months, with stable system parameters and no infection relapse.