Implantation of a fully subcutaneous ICD in a patient with single ventricle morphology and Eisenmenger physiology.

Implantable cardioverter-defibrillator (ICD) therapy has been adopted increasingly in congenital heart disease. However, in patients with intracardiac right-to-left shunting the use of standard transvenous ICD lead systems is relatively contraindicated due to the increased risk of systemic thromboembolism. In this constellation, a recently introduced totally subcutaneous ICD system (S-ICD) seems to be a good and minimal invasive alternative to conventional epicardial ICD therapy. Here we describe the first use of this S-ICD in a patient with single ventricle and Eisenmenger physiology. In this unusual cardiac anatomy modification of the standard implantation technique by use of short sequences of fluoroscopy helped to ensure exact electrode and can placement and thus regular function of the S-ICD system.