Japanese Journal of Electrocardiology
Online ISSN : 1884-2437
Print ISSN : 0285-1660
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  • Saori Nobusada, Motomi Tachibana, Nobuhiro Nishii, Tomomi Hosokawa, Na ...
    Volume 37 (2017) Issue 4 Pages 243-254
    Released: April 16, 2018
    JOURNALS FREE ACCESS

    Totally subcutaneous implantable cardioverter-defibrillator(S-ICD)system has been available in Japan since February 2016. S-ICD avoids important periprocedual and long-term complications associated with transvenous leads of the conventional ICD such as lead dislodgement or infective endocarditis. To assess who is suitable for S-ICD, patients are required one lead to satisfy the S-ICD screening template. However, evaluation of the screening ECG only performed once while at rest may be insufficient for patients with diurnal variation and day-to-day variations of ECG such as Brugada syndrome(BrS). Here we report a case of BrS who passed the S-ICD template one day, but failed another day. A 58 year-old man with BrS came to our hospital for lead injury of implantable cardioverter-defibrillator(ICD). S-ICD implantation was considered for him. He passed S-ICD template one day but failed another day. Therefore, he was assessed by treadmill exercise test and Holter ECG to simulate the 3 S-ICD sensing vectors. During these tests, the eligibility of S-ICD changed dramatically, and we gave up implanting S-ICD for him. The ECG morphology changes dramatically by situation in patients with BrS. Holter ECG and exercise stress test should be considered before S-ICD implantation in patients with BrS.

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