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.