Subcutaneous implantable defibrillator

Case contributed by Jayanth Keshavamurthy


On echocardiogram the LV function has worsened and there are new wall motion abnormalities. The left ventricle is mildly dilated. There is mild concentric left ventricular hypertrophy. The mid and distal anterior wall, anterospetum, and apex are akinetic; otherwise global hypokinesis. Left ventricular systolic function is severely reduced. The left ventricular ejection fraction is 20-25%.

Patient Data

Age: 50
Gender: Female

External ICD (SCID) power pack is noted. ICD lead overlies the anterior sternum.

Lateral view has the clue why this kind of ICD was used.

Surgical clips in arm likely from AV graft or vascular access.

Case Discussion

Procedures performed:

  • left heart Cath w/Coronary Angiography, No LV Gram
  • IFR Initial Vessel (Pressure Wire WITHOUT adenosine)


  • elevated EDP
  • critical calicified disease of LAD and RCA
  • Nonobstructive Cx

The subcutaneous lead  advantage include no risk of heart perforation or valve problems.

Can be used in patients with poor IV access as in Chronic renal failure.

Please read the article in reference in detail for advantages and disadvantages.

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