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Low QRS voltage and atrial fibrillation precluding implantation of a subcutaneous implantable cardioverterdefibrillator in a patient with arrhythmogenic cardiomyopathy

Peter C. Kahr, Jan Steffel, Alexander Breitenstein, Thomas Wolber, Laurent M. Haegeli, Deniz Akdis, Firat Duru, Corinna Brunckhorst, Ardan M. Saguner
  • Peter C. Kahr
    Department of Cardiology, University Heart Centre Zurich; Department of Medicine, University Hospital Zurich, Zurich, Switzerland | pckahr@gmail.com
  • Jan Steffel
    Department of Cardiology, University Heart Centre Zurich, Zurich, Switzerland
  • Alexander Breitenstein
    Department of Cardiology, University Heart Centre Zurich, Zurich, Switzerland
  • Thomas Wolber
    Department of Cardiology, University Heart Centre Zurich, Zurich, Switzerland
  • Laurent M. Haegeli
    Department of Cardiology, University Heart Centre Zurich, Zurich, Switzerland
  • Deniz Akdis
    Department of Cardiology, University Heart Centre Zurich, Zurich, Switzerland
  • Firat Duru
    Department of Cardiology, University Heart Centre Zurich, Zurich, Switzerland
  • Corinna Brunckhorst
    Department of Cardiology, University Heart Centre Zurich, Zurich, Switzerland
  • Ardan M. Saguner
    Department of Cardiology, University Heart Centre Zurich, Zurich, Switzerland

Abstract

Arrhythmogenic cardiomyopathy (AC) is a rare mostly hereditary disease, in which fibro-fatty tissue replaces cardiomyocytes. Typically, the first alterations of the disease can be encountered in the epicardium of the right ventricle in adolescent patients. From there, the disease usually progresses over time. Besides the development of heart failure, the clinical significance of the disease is determined by the predisposition to potentially lethal ventricular arrhythmias. Hence, a majority of patients with AC require an implantable cardioverter-defibrillator (ICD) to be protected from sudden cardiac death. A recently developed alternative to transvenous systems are subcutaneous ICDs (S-ICD), associated with a lower risk of device-related complications such as endocarditis since no foreign material is implanted within the heart and vascular system. In this report, we describe and discuss our experience with the implantation of a S-ICD in a patient with AC, who had low QRS voltage and persistent atrial fibrillation precluding successful S-ICD implantation, as well as the challenges encountered during subsequent transvenous lead implantation.

Keywords

Arrhythmogenic right ventricular cardiomyopathy; subcutaneous implantable cardioverter/defibrillator; arrhythmia; sudden cardiac death.

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Submitted: 2017-08-26 23:27:01
Published: 2017-12-20 11:00:56
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Copyright (c) 2017 Peter C. Kahr, Jan Steffel, Alexander Breitenstein, Thomas Wolber, Laurent M. Haegeli, Deniz Akdis, Firat Duru, Corinna Brunckhorst, Ardan M. Saguner

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