Ventricular tachycardia and sudden cardiac death might complicate the long-term outcome by patients after tetralogy of Fallot repair

Abstract

Implantable cardioverter-defibrillator implantation is an important adjunct in the management of these patients, although cardiac device endocarditis is an infrequent, but potentially lethal infectious complication. Cure of cardiac device endocarditis is achievable in the large majority of patients treated with an aggressive approach of combined antimicrobial treatment and complete cardiac device removal. Re-implantation of the device requires additional caution, but still associated with increased risk for recurrences. The aim of this case presentation is to demonstrate the feasibility of permanent subcutaneous defibrillation system in a patient with recurrent endocarditis. In our case a 37-year-old patient--operated several times due to Fallot tetralogy, with permanent pacemaker and later implantable cardioverter defibrillator, requiring several replacements--was treated with recurrent device endocarditis. After device explantation and long-term standard antibiotic treatment, in order to decrease further risk for the development of recurrent endocarditis, we implanted a defibrillation system with an individually designed subcutaneous lead configuration. This case report suggests that individually tailored defibrillator lead configuration is a feasible option for patients until a fully automatic effective subcutaneous system will be available.