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Implantation of a completely subcutaneous ICD system: case report of a patient with Brugada syndrome and state of the art

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Abstract

Aims

Complications of implantable cardioverter-defibrillator (ICD) therapy are often linked to transvenous lead insertion, lead failure, or infections. An entirely subcutaneous ICD system (S-ICD) avoids the need for the placement of electrodes within the heart and can provide clinical advantages.

Methods and results

A 45-year-old patient with Brugada syndrome (spontaneous type 1 Brugada ECG, syncope during fever, family history of sudden death <45 years old) was implanted with an entirely S-ICD. A left lateral incision was made over the sixth rib in the anterior axillary line for pocket formation and pulse generator placement. The subcutaneous electrode was placed subcutaneously, parallel to and 2 cm to the left of the sternal midline, and was connected to the generator. The insertion of the system was guided only by anatomical landmarks, and no fluoroscopy was required. Ventricular fibrillation was induced and terminated by a 65-J shock (15-J safety margin). No complication occurred, and subsequent course was uneventful.

Conclusions

S-ICD is a new system for delivering lifesaving shock therapy in patients at risk of sudden cardiac death, without the need of intracardiac leads. Young patients with inherited arrhythmogenic syndromes could benefit the most from this system. This is the first case of Brugada syndrome implanted with a first-generation S-ICD in Italy.

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Authors and Affiliations

  1. Cardiology Unit, Ramazzini Hospital, Via Molinari, Carpi, Modena, Italy, 41012

    Elia De Maria, Lorenzo Bonetti, Giampiero Patrizi & Stefano Cappelli

  2. Cameron Health BV, Arnhem, The Netherlands

    John Scrivener

  3. MedicoPace s.r.l, Rubano, Padova, Italy

    Alberto Andraghetti, Franco Di Gregorio, Alessio Montin & Giulia Zuccon

Authors
  1. Elia De Maria
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  2. Lorenzo Bonetti
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  3. Giampiero Patrizi
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  4. John Scrivener
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  5. Alberto Andraghetti
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  6. Franco Di Gregorio
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  7. Alessio Montin
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  8. Giulia Zuccon
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  9. Stefano Cappelli
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Corresponding author

Correspondence to Elia De Maria.

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De Maria, E., Bonetti, L., Patrizi, G. et al. Implantation of a completely subcutaneous ICD system: case report of a patient with Brugada syndrome and state of the art. J Interv Card Electrophysiol 34, 105–113 (2012). https://doi.org/10.1007/s10840-011-9626-5

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  • DOI: https://doi.org/10.1007/s10840-011-9626-5

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