Successful implantable cardioverter defibrillator placement in an ambulatory patient without thoracic venous access.

Evaluation of an individual requiring permanent cardiac pacing and implantable cardioverter defibrillator (ICD) function revealed no suitable thoracic vascular access for traditional device implantation. Because the patient refused cardiac surgery, a left femoral venous approach was used to introduce two extended-length, active fixation leads that were positioned in the right atrium and ventricle. The leads were tunneled to the abdomen and connected to a dual-chamber ICD. A low defibrillation threshold and robust pacing and sensing parameters were observed at implant. All of these parameters were stable at 6-month follow-up. In addition, no negative effects of the predominantly abdominal shock vector were observed. This case suggests that femoral ICD placement should be considered before routinely referring such patients for open chest surgery.