Abstract
Arrhythmogenic cardiomyopathy (AC) is a rare mostly hereditary disease, in which fibro-fatty tissue replaces cardiomyocytes. Typically, the first alterations of the disease can be encountered in the epicardium of the right ventricle in adolescent patients. From there, the disease usually progresses over time. Besides the development of heart failure, the clinical significance of the disease is determined by the predisposition to potentially lethal ventricular arrhythmias. Hence, a majority of patients with AC require an implantable cardioverter-defibrillator (ICD) to be protected from sudden cardiac death. A recently developed alternative to transvenous systems are subcutaneous ICDs (S-ICD), associated with a lower risk of device-related complications such as endocarditis since no foreign material is implanted within the heart and vascular system. In this report, we describe and discuss our experience with the implantation of a S-ICD in a patient with AC, who had low QRS voltage and persistent atrial fibrillation precluding successful S-ICD implantation, as well as the challenges encountered during subsequent transvenous lead implantation.
Highlights
Low QRS voltage and atrial fibrillation precluding implantation of a subcutaneous implantable cardioverterdefibrillator in a patient with arrhythmogenic cardiomyopathy
N tion of a S-implantable cardioverter-defibm rillator (ICD) in a patient with Arrhythmogenic cardiomyopathy (AC), who had low QRS voltage and persistent atrial fibrillation precluding successful subcutao neous ICDs (S-ICD) implantation, as well as the challenges encountered during subsequent transvenous lead implantation
Transvenous implantable cardioverter-defibrillators (TV-ICDs) are implanted in the majority of AC patients that are at increased risk of developing lifethreatening arrhythmias.[1]
Summary
Low QRS voltage and atrial fibrillation precluding implantation of a subcutaneous implantable cardioverterdefibrillator in a patient with arrhythmogenic cardiomyopathy. N tion of a S-ICD in a patient with AC, who had low QRS voltage and persistent atrial fibrillation precluding successful S-ICD implantation, as well as the challenges encountered during subsequent transvenous lead implantation.
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