Successful Right Sided Subcutaneous Implantable Cardioverter-Defibrillator Implantation in Situs Inversus...

This case report details the successful implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) in a 70-year-old male with situs inversus dextrocardia, a rare congenital condition where the heart and visceral organs are reversed. The patient, with a history of ischemic heart disease and severe left ventricular dysfunction (ejection fraction 25%), required primary prevention of sudden cardiac death. Due to anatomical challenges with transvenous ICD placement and no need for pacing or resynchronization, an S-ICD was selected. Pre-procedural screening was modified by reversing electrode positions to accommodate the right-sided heart, ensuring eligibility across all sensing vectors. The S-ICD was implanted using a two-incision technique, positioning the generator in the right midaxillary line and the electrode along the left parasternal area. Defibrillation threshold testing confirmed effective termination of induced ventricular fibrillation with a 60 J shock. No complications occurred, and 1-month follow-up verified normal device function. This case demonstrates the adaptability and safety of S-ICD implantation in dextrocardia, emphasizing tailored screening and procedural adjustments. A review of existing literature shows consistent success with S-ICDs in similar patients, though device placement varies. This report adds to the evidence supporting S-ICD use in complex congenital anatomies, providing valuable guidance for clinicians.