Eaton Holden, Aggour Hesham, Ormerod Julian O M
University of Oxford Medical School, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
Department of Cardiovascular Medicine, University of Oxford, Wellington Square, Oxford OX1 2JD, UK.
Eur Heart J Case Rep. 2025 Jul 17;9(8):ytaf331. doi: 10.1093/ehjcr/ytaf331. eCollection 2025 Aug.
Implantable cardioverter-defibrillators (ICDs) prevent sudden cardiac death due to ventricular arrhythmia. A novel extravascular ICD (EV-ICD) system provides improved functionality over previous transvenous (TV-ICD) and subcutaneous (S-ICD) alternatives, particularly in younger patients. This includes limited bradycardia pacing, anti-tachycardia pacing therapy, and lower energy defibrillation, all within a smaller device profile compared to the S-ICD. Due to the need for substernal lead placement, however, complex sternal anatomy is currently considered a relative contraindication to their use.
We present a 38-year-old male patient with pectus excavatum and a previous episode of ventricular fibrillation leading to out-of-hospital cardiac arrest. Initial implantation of a S-ICD was associated with repeated inappropriate shocks over 4 years, leading to multidisciplinary discussions with the patient regarding off-label use of an EV-ICD, as approved by Medtronic CRM. Explantation of the S-ICD and implantation of the EV-ICD were successful, with minimal technical changes required compared to standard surgical technique in normal sternal anatomy. At 6-month follow-up, there were no complications or inappropriate shocks.
The EV-ICD may be considered in patients with pectus excavatum, making this novel device available to a larger proportion of patients. Aside from careful consideration of instrument positioning during the procedure, this can be done with minimal changes to the standard surgical protocol.
植入式心脏复律除颤器（ICD）可预防因室性心律失常导致的心脏性猝死。一种新型的血管外ICD（EV-ICD）系统相比以往的经静脉（TV-ICD）和皮下（S-ICD）替代方案具有更好的功能，尤其是在年轻患者中。这包括有限的心动过缓起搏、抗心动过速起搏治疗以及较低能量的除颤，且与S-ICD相比，该设备外形更小。然而，由于需要将电极导线置于胸骨下，目前复杂的胸骨解剖结构被认为是使用它们的相对禁忌证。
我们报告一名38岁男性患者，患有漏斗胸，曾发生过一次室颤导致院外心脏骤停。最初植入S-ICD在4年中反复出现不适当电击，导致与患者就经美敦力CRM批准的EV-ICD的标签外使用进行多学科讨论。成功取出S-ICD并植入EV-ICD，与正常胸骨解剖结构的标准手术技术相比，所需的技术改变最小。在6个月的随访中，没有并发症或不适当电击。
对于漏斗胸患者可考虑使用EV-ICD，从而使更多患者能够使用这种新型设备。除了在手术过程中仔细考虑器械定位外，这可以在对标准手术方案进行最小改变的情况下完成。
