Life-Saving Cooperative Function of a Subcutaneous Cardioverter-Defibrillator and a Pacemaker in Dextrocardia With Heart Failure

Abstract

A 47-year-old man with congenitally corrected transposition of the great arteries, dextrocardia, heart failure, and pacemaker-dependency presented with nonsustained ventricular tachycardia. He underwent a right-sided transmuscular cardioverter-defibrillator insertion after appropriate testing. One year later, life-saving antiarrhythmic therapy was applied by the subcutaneous defibrillator while the appropriate pacemaker functioning supported heart rhythm.

Keywords: congenitally corrected transposition of the great arteries; dextrocardia; pacemaker; subcutaneous defibrillator.

Graphical abstract

Figure 1

Cardiac Magnetic Resonance Image Conducted Just Before Pacemaker Implantation Note that the apex of the heart is pointing to the right, and this is a mirror image of a congenitally corrected transposition of the great arteries heart to the right side of the thorax. The right ventricle in an anterior-upper position is connected to the left atrium, not the right atrium, in the context of the congenitally corrected transposition of the great arteries.

Figure 2

Right-Sided Subcutaneous Implantable Cardioverter-Defibrillator A right-sided subcutaneous implantable cardioverter-defibrillator was implanted intermuscularly, with the defibrillator lead on the left. The pre-existing transvenous pacemaker is also right-sided.

Figure 3

Electrocardiogram of a Rapid Ventricular Tachyarrhythmia Α rapid ventricular tachyarrhythmia was promptly treated by the defibrillator, whereas pacemaker activity resumed evenly after high-voltage therapy. After successful defibrillation (third electrocardiographic strip, end), the sensed ventricular rhythm (S) is pacemaker-mediated (fourth and fifth electrocardiographic strip). The pacemaker was programmed in VVIR mode, 60-110 beats/min, pacing output 3/0.4 V/ms, bipolar sense 4 mV.