# Successful Right Sided Subcutaneous Implantable Cardioverter‐Defibrillator Implantation in Situs Inversus Dextrocardia: A Case Report and Literature Review

## TL;DR

A subcutaneous ICD was successfully implanted in a patient with situs inversus dextrocardia, showing it can be a safe option for preventing sudden cardiac death in such rare anatomies.

## Contribution

Demonstrates the feasibility and safety of S-ICD implantation in situs inversus dextrocardia with modified screening and electrode positioning.

## Key findings

- S-ICD implantation was successful with no complications and normal device function at 1-month follow-up.
- Tailored pre-procedural screening and electrode positioning ensured eligibility across all sensing vectors.
- Literature review confirms consistent success of S-ICDs in similar patients despite variable device placement.

## Abstract

This case report details the successful implantation of a subcutaneous implantable cardioverter‐defibrillator (S‐ICD) in a 70‐year‐old male with situs inversus dextrocardia, a rare congenital condition where the heart and visceral organs are reversed. The patient, with a history of ischemic heart disease and severe left ventricular dysfunction (ejection fraction 25%), required primary prevention of sudden cardiac death. Due to anatomical challenges with transvenous ICD placement and no need for pacing or resynchronization, an S‐ICD was selected. Pre‐procedural screening was modified by reversing electrode positions to accommodate the right‐sided heart, ensuring eligibility across all sensing vectors. The S‐ICD was implanted using a two‐incision technique, positioning the generator in the right midaxillary line and the electrode along the left parasternal area. Defibrillation threshold testing confirmed effective termination of induced ventricular fibrillation with a 60 J shock. No complications occurred, and 1‐month follow‐up verified normal device function. This case demonstrates the adaptability and safety of S‐ICD implantation in dextrocardia, emphasizing tailored screening and procedural adjustments. A review of existing literature shows consistent success with S‐ICDs in similar patients, though device placement varies. This report adds to the evidence supporting S‐ICD use in complex congenital anatomies, providing valuable guidance for clinicians.

Subcutaneous ICD implantation is feasible and safe in situs inversus dextrocardia with tailored pre‐procedural screening and electrode positioning, offering effective primary prevention of sudden cardiac death in patients with complex congenital anatomies.