Background: Subcutaneous implantable cardioverter-defibrillator (S-ICD) infection can be managed conservatively, shifting the generator from the submuscular to intermuscular pocket. Case Summary: A 50-year-old man with hypertrophic cardiomyopathy and an S-ICD implanted as primary prevention with the intermuscular pocket technique was admitted to the cardiology department for a check-up owing to evidence of a pseudonodular skin lesion over the catheter sleeve that developed after having shaved the chest. Positron emission tomography/computed tomography scan was performed and revealed an active infection both over the S-ICD generator and along the lead. The patient declined transvenous ICD reimplantation, so we performed a revised shift and cover technique, shifting the pocket from intermuscular to submuscular. Efficacy of the procedure was confirmed on 8-months follow-up positron emission tomography/computed tomography. Discussion: The S-ICD shift and cover technique is safe and effective when performed in a patient with an infected intermuscular pocket. Take-Home Message: Tailored strategies of S-ICD reimplantation should always be pursued in patients without fear of going beyond the serratus anterior muscle.
Not Afraid to Go Beyond: Innovative Management of Intermuscular S-ICD Infection / Cocchiara, L.; Brescia, B.; Nardi, S.; Salucci, A.; Addeo, L.; Visconti, P.; Strisciuglio, T.; Vergara, P.; Esposito, G.; Rapacciuolo, A.. - In: JACC. CASE REPORTS. - ISSN 2666-0849. - 30:20(2025). [10.1016/j.jaccas.2025.104176]
Not Afraid to Go Beyond: Innovative Management of Intermuscular S-ICD Infection
Cocchiara L.;Salucci A.;Strisciuglio T.;Vergara P.;Esposito G.;Rapacciuolo A.
2025
Abstract
Background: Subcutaneous implantable cardioverter-defibrillator (S-ICD) infection can be managed conservatively, shifting the generator from the submuscular to intermuscular pocket. Case Summary: A 50-year-old man with hypertrophic cardiomyopathy and an S-ICD implanted as primary prevention with the intermuscular pocket technique was admitted to the cardiology department for a check-up owing to evidence of a pseudonodular skin lesion over the catheter sleeve that developed after having shaved the chest. Positron emission tomography/computed tomography scan was performed and revealed an active infection both over the S-ICD generator and along the lead. The patient declined transvenous ICD reimplantation, so we performed a revised shift and cover technique, shifting the pocket from intermuscular to submuscular. Efficacy of the procedure was confirmed on 8-months follow-up positron emission tomography/computed tomography. Discussion: The S-ICD shift and cover technique is safe and effective when performed in a patient with an infected intermuscular pocket. Take-Home Message: Tailored strategies of S-ICD reimplantation should always be pursued in patients without fear of going beyond the serratus anterior muscle.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
