title: Implantation of a completely subcutaneous ICD system: case report of a patient with Brugada syndrome and state of the art.
abstract: OBJECTIVE
  Complications of implantable cardioverter-defibrillator (ICD) therapy are often linked to transvenous lead insertion, lead failure, or infections. An entirely subcutaneous ICD system (S-ICD) avoids the need for the placement of electrodes within the heart and can provide clinical advantages.
  
  
  RESULTS
  A 45-year-old patient with Brugada syndrome (spontaneous type 1 Brugada ECG, syncope during fever, family history of sudden death <45 years old) was implanted with an entirely S-ICD. A left lateral incision was made over the sixth rib in the anterior axillary line for pocket formation and pulse generator placement. The subcutaneous electrode was placed subcutaneously, parallel to and 2 cm to the left of the sternal midline, and was connected to the generator. The insertion of the system was guided only by anatomical landmarks, and no fluoroscopy was required. Ventricular fibrillation was induced and terminated by a 65-J shock (15-J safety margin). No complication occurred, and subsequent course was uneventful.
  
  
  CONCLUSIONS
  S-ICD is a new system for delivering lifesaving shock therapy in patients at risk of sudden cardiac death, without the need of intracardiac leads. Young patients with inherited arrhythmogenic syndromes could benefit the most from this system. This is the first case of Brugada syndrome implanted with a first-generation S-ICD in Italy.
authors: Cardiology Unit, Ramazzini Hospital, Via Molinari, Carpi, Modena, Italy, 41012. e.demaria@inwind.it
authors: Elia
authors: E
authors: De Maria
authors: Lorenzo
authors: L
authors: Bonetti
authors: Giampiero
authors: G
authors: Patrizi
authors: John
authors: J
authors: Scrivener
authors: Alberto
authors: A
authors: Andraghetti
authors: Franco
authors: F
authors: Di Gregorio
authors: Alessio
authors: A
authors: Montin
authors: Giulia
authors: G
authors: Zuccon
authors: Stefano
authors: S
authors: Cappelli
mesh_terms: D053840:Brugada Syndrome / Q000175:diagnosis* / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome