Successful EV ‐ ICD Implantation After Removal of Both TV ‐ ICD and S‐ ICD : A Case Report – “Third Time Is the Charm.”

ABSTRACT Introduction Extravascular implantable cardioverter‐defibrillator (EV‐ICD) is a novel therapy with a high‐voltage lead implanted in the substernal space. We encountered a case in which an EV‐ICD was implanted following the extraction of both a transvenous ICD (TV‐ICD) and a subcutaneous ICD (S‐ICD). Clinical Background and Results A 65‐year‐old male had initially received a transvenous ICD for idiopathic ventricular fibrillation 11 years prior to presentation, which was extracted due to infection. Although a S‐ICD was implanted after that, he had experienced repetitive inappropriate ICD shocks due to P‐wave oversensing, T‐wave oversensing, and myopotential oversensing. Then, an EV‐ICD was implanted after S‐ICD extraction. We asked the patient to complete the Florida Patient Acceptance Survey (FPAS) about three types of ICD. The FPAS score was highest in EV‐ICD. Conclusion This unique case provides insight on patient acceptance from a patient with first‐hand experience with all three ICD types and “the third ICD was the charm.”