A patient with congenital heart disease and ventricular tachycardia: what is the course of the device lead?

A 16-year-old boy with Ebstein's anomaly of the tricuspid valve developed exercise-induced rapid ventricular tachycardia. He had previously undergone tricuspid valvuloplasty and bidirectional cavopulmonary anastamosis due to progressive symptoms. A single-chamber implantable cardioverter-defibrillator was implanted, utilizing a novel transvenous approach to the right ventricle. Technical considerations, risks, and benefits of this approach are discussed.