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Late Obesity‐Driven Subcutaneous ICD Geometric Failure: Salvage With Sub‐Serratus Generator Repositioning

Year: 2026

Type: article

Abstract: S-ICD efficacy depends on extracardiac shock vector geometry. We report late obesity-associated geometric deterioration after substantial weight gain. Rising shock impedance prompted reassessment at generator replacement, revealing pocket dehiscence, adipose interposition, and generator superficialization. Because fibrosis precluded parasternal lead mobilization by simple traction, sub-serratus generator repositioning improved the PRAETORIAN score and shock impedance. Despite a subsequent rise to 130 Ω, defibrillation succeeded with a 65 J shock. S-ICD geometry should be considered dynamic, particularly after major changes in body habitus.

Source: Pacing and Clinical Electrophysiology

DOI: 10.1111/pace.70482

Authors: Federico Turreni, Pietro Francia, Maria Luisa Loricchio, Renzo Iulianella, Antonino Granatelli, Marco Testa

Institutions: Ospedale Sandro Pertini, Azienda Ospedaliera Sant'Andrea, Sapienza University of Rome

Language: English

Topic: Cardiac pacing and defibrillation studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

OpenAlex ID: W7223929659

FWCI:

Cites: 10

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Related to: 10