Case presentation
The patient is a 50-year-old male with a past medical history of hypertrophic cardiomyopathy, non-sustained ventricular tachycardia, and evidence of late gadolinium enhancement on MRI consistent with fibrosis. After a shared decision-making discussion, he underwent implantation of S-ICD for primary prevention of sudden cardiac death. Of note, the pulse generator was secured to the fascia with two 0-Silk sutures as part of standard procedure and two non-absorbable, braided sutures were placed at the sub-xiphoid incision to tie down the lead around the suture sleeve, and the lead was tunneled up along the sternum. During the first follow-up visit 2 weeks post-implant, the S-ICD interrogation showed appropriate device function. Two weeks later, remote monitoring reported one ICD shock due to an event categorized as ventricular fibrillation (Figure 1). Interrogation demonstrated reduced R wave amplitude and an abnormal impedance of 7 ohms during shock delivery. Patient reported no symptoms prior to the shock but was clapping hands to music when it occurred. A chest X-ray revealed the S-ICD lead was dislodged and retracted, with coiling around the generator in left lateral chest wall (Figure 2A and 2B) compared to the original post-implant position (Figure 2C and 2D). Subsequently, the patient underwent lead revision and device replacement. To reduce the risk of future dislodgement, during re-implantation, an incision was made near the expected position of the tip of the ICD lead, which was then secured with 0-Silk to prevent dislodgment.