B-PO02-217 NOVEL SOLUTION TO THE MIGRATION OF A TRANSVENOUS ICD PULSE GENERATOR

Abstract

Migration of a submammary transvenous ICD (TV-ICD) pulse generator is an uncommon event that can be exacerbated by the presence of a saline breast implant, and can impact defibrillation threshold (DFT). Device relocation may become necessary. To describe the successful relocation of a submammary TV-ICD to a mid-axillary pocket of a prior subcutaneous ICD (S-ICD), in a patient whose device migrated anterior to a saline breast implant resulting in an acute change in shock impedance. N/A A 38-year-old female with a history of bi-lateral saline breast implants (2000) and malignant mitral valve prolapse with PVC-induced ventricular fibrillation underwent a secondary-prevention S-ICD implant, which was eventually removed for inappropriate shocks. A single-chamber TV ICD was then implanted in a left-sided submammary position, underneath a saline breast implant. Four months after implant there was an acute rise in high-voltage (HV) impedance (> 110 ohms), corresponding to migration of the TV ICD generator anterior to the breast implant (Figure A and B). Patient declined re-location to the prior submammary position and a traditional pre-pectoral (infraclavicular) position (for aesthetic reasons). As such, the TV ICD pulse generator was repositioned to the mid-axillary position, previously used for the S-ICD implant (Figure C and D). DFT was successful (45 ohms) and HV impedance normalized and remained within normal range at follow-up (Figure E and F). Implantation of TV ICD pulse generator in the mid-axillary location can be considered for patients in whom submammary or infraclavicular positions are either not desired or not feasible.