PMC6379875_01
Echocardiogram: (a) parasternal long axis view showing right and left ventricular dilatation, (b) M-mode with left ventricular measurements, and (c) parasternal short axis view at mitral valve level with biventricular enlargement.
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fig1
He had severe biventricular dysfunction (left ventricular ejection fraction < 25%, Figure 1) with frequent heart failure admissions requiring intermittent inotropic support, and he was on the waiting list for heart transplantation.
12-lead electrocardiogram showing atrial fibrillation with a ventricular rate of 104 beats per minute and right bundle branch block.
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An electrocardiogram (ECG) showed AF and right bundle branch block with a QRS duration of 164 milliseconds (ms) (Figure 2).
Nonsustained ventricular tachycardia on telemetry with two different morphologies.
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fig3
He had premature ventricular complexes (PVCs) and runs of nonsustained ventricular tachycardia (VT) up to 5 beats at 187 beats per minute documented in telemetry and 24-hour Holter monitoring (Figure 3).
(a) Manual ECG screening test showing only lead I (alternate vector) in supine and sitting positions as acceptable vector at 10 mm/mV. (b) Postimplantation S-ECG sensing with gain setting 1X showing adequate sensing in the primary, secondary, and alternate vectors. The primary vector was automatically selected. S: subcutaneous.
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The S-ICD ECG screening showed only an alternate vector to be acceptable in the supine and sitting positions (Figure 4(a)). The S-ICD analysis at the end of the procedure revealed acceptable three sensing factors (primary, secondary, and alternate) (Figure 4(b)).
Posteroanterior (a) and lateral (b) chest x-rays showing situs inversus totalis, pectus excavatum, sternal wires from previous cardiac surgeries, and the S-ICD device and electrode. Note the presence of cardiomegaly, small left pleural effusion, and basilar atelectasis. S-ICD: subcutaneous implantable cardioverter defibrillator.
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The chest X-ray showed an acceptable lead and device position (Figure 5). The patient made a good recovery with no complication related to the procedure.