PMC5775443_01
A: Radiograph in straight posterior-anterior (PA) view showing position of subcutaneous implantable cardioverter-defibrillator lead after repositioning with successful defibrillator testing at 65 J. B: Computed tomography image demonstrating improved shock vector. Initial lead position (red arrow) and final lead position (green arrow). C: Initial lead position, which failed to defibrillate at 80 J, in straight PA view.
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Paul, MN- A 209 Emblem) placed over the left lateral chest wall muscle (Figure 1B, white arrow) and a Boston Scientific 3401 Emblem S-ICD 45 cm lead tunneled immediately over the fascial layer in the left parasternal position using the 3-incision technique. Fluoroscopy revealed that the lead position was lateral to the midline (Figure 1C; position C). The lead was then re-tunneled and placed 2 cm more medially and directly adjacent to the sternum (Figure 1A; position A). His follow-up computed tomography (CT) demonstrates that the shock vector improved following the lead repositioning from position C (Figure 1B, red arrow) to position A (Figure 1B, green arrow).