Importance of visualizing the anatomical location of the latissimus dorsi muscle using computed tomography for a robust reimplantation of a subcutaneous implantable cardioverter-defibrillator

The intermuscular technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantations is a technique for implanting the device between the anterior serratus muscle and latissimus dorsi (LD) muscle. A 70-year-old hypertrophic cardiomyopathy patient underwent a surgical repositioning of an S-ICD due to a moved device with skin thinning from mechanical stress. The patient had an S-ICD implantation 4 years prior to the reimplantation and the intermuscular technique was not expected to be achieved. The locational relationship of the S-ICD and LD was visually confirmed by computed tomography (CT), which was useful for planning the reimplantation. The device was reimplanted under the LD, with a position slightly cranial to the apex, and the defibrillation test was successful at 65 J. Our case suggested that preoperative CT imaging detailing the location of the implanted device and LD was practical for an optimal repositioning of an S-ICD.

Learning objective

The traditional technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantations is associated with pocket-related skin problems in patients who lack sufficient subcutaneous tissue to adequately cover the device. Therefore, the submuscular approach has been used as an alternative technique for safety. In the event of an S-ICD malposition during the long-term follow-up, computed tomography imaging is helpful in identifying the detailed anatomy of the latissimus dorsi muscle and determining the optimal device reimplantation site.