Implantation of a subcutaneous implantable cardioverter defi
Implantable cardioverter defibrillator (ICD) therapy is indicated in patients with structural heart disease who have had an aborted cardiac arrest (ACA). After atrial repair of d-transposition of the great arteries (d-TGA, Mustard repair) patients seem to be at a higher risk of failing intraoperative subcutaneous ICD (S-ICD) shock testing.

Published in the European Heart Journal - Case Reports, the authors present a case of a 45-year-old patient with congenital heart disease (CHD) who suffered a cardiac arrest from ventricular fibrillation and was subsequently implanted with a S-ICD.

The authors describe the challenges of ICD therapy in patients after Mustard procedure for d-TGA, with the additional challenge of concomitant AAI pacemaker therapy. In this patient, we opted for the implantation of an S-ICD, and detail the necessary considerations and operative technique employed in this patient. A right parasternal electrode position was chosen and intraoperative shock testing was successful.

Learning points
• Congenital heart disease patients after aborted sudden cardiac death require an individualized approach to implantable cardioverter defibrillator (ICD) therapy.

• Subcutaneous ICD (S-ICD) therapy is a feasible and safe alternative in certain cases, but electrode placement requires special considerations in patients with d-transposition of the great arteries.

• Although concomitant S-ICD therapy in patients with a pacemaker is not recommended, it is feasible and safe in individual cases.

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