{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:24:18Z","timestamp":1792736658558,"version":"4.5.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Implantable cardioverter-defibrillators (ICDs) prevent sudden cardiac death due to ventricular arrhythmia. A novel extravascular ICD (EV-ICD) system provides improved functionality over previous transvenous (TV-ICD) and subcutaneous (S-ICD) alternatives, particularly in younger patients. This includes limited bradycardia pacing, anti-tachycardia pacing therapy, and lower energy defibrillation, all within a smaller device profile compared to the S-ICD. Due to the need for substernal lead placement, however, complex sternal anatomy is currently considered a relative contraindication to their use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We present a 38-year-old male patient with pectus excavatum and a previous episode of ventricular fibrillation leading to out-of-hospital cardiac arrest. Initial implantation of a S-ICD was associated with repeated inappropriate shocks over 4 years, leading to multidisciplinary discussions with the patient regarding off-label use of an EV-ICD, as approved by Medtronic CRM. Explantation of the S-ICD and implantation of the EV-ICD were successful, with minimal technical changes required compared to standard surgical technique in normal sternal anatomy. At 6-month follow-up, there were no complications or inappropriate shocks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The EV-ICD may be considered in patients with pectus excavatum, making this novel device available to a larger proportion of patients. Aside from careful consideration of instrument positioning during the procedure, this can be done with minimal changes to the standard surgical protocol.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf331","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T14:14:20Z","timestamp":1752502460000},"source":"Crossref","is-referenced-by-count":2,"title":["Successful implantation of an extravascular implantable cardioverter-defibrillator in a patient with moderate pectus excavatum: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9779-1017","authenticated-orcid":false,"given":"Holden","family":"Eaton","sequence":"first","affiliation":[{"name":"University of Oxford Medical School, John Radcliffe Hospital , Headley Way, Headington, Oxford OX3 9DU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4825-4002","authenticated-orcid":false,"given":"Hesham","family":"Aggour","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, University of Oxford , Wellington Square, Oxford OX1 2JD ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1612-8992","authenticated-orcid":false,"given":"Julian O M","family":"Ormerod","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, University of Oxford , Wellington Square, Oxford OX1 2JD ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,17]]},"reference":[{"key":"2025080112530283500_ytaf331-B1","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1093\/eurheartj\/ehx758","article-title":"European Sudden Cardiac Arrest network: towards Prevention, Education and New Effective Treatments (ESCAPE-NET): a major European Horizon 2020 project focused on cardiac arrest","volume":"39","author":"Tan","year":"2018","journal-title":"Eur Heart J"},{"key":"2025080112530283500_ytaf331-B2","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur Heart J"},{"key":"2025080112530283500_ytaf331-B3","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.jacc.2023.04.056","article-title":"Development of the implantable cardioverter-defibrillator: JACC historical breakthroughs in perspective","volume":"82","author":"Maron","year":"2023","journal-title":"J Am Coll 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results","volume":"110","author":"Wathen","year":"2004","journal-title":"Circulation"},{"key":"2025080112530283500_ytaf331-B9","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1093\/europace\/euy161","article-title":"Successful implantation of subcutaneous implantable cardioverter-defibrillator in a patient with severe pectus excavatum","volume":"20","author":"Karvouni","year":"2018","journal-title":"Europace"},{"key":"2025080112530283500_ytaf331-B10","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1056\/NEJMoa2206485","article-title":"Efficacy and safety of an extravascular implantable cardioverter\u2013defibrillator","volume":"387","author":"Friedman","year":"2022","journal-title":"N Engl J Med"},{"key":"2025080112530283500_ytaf331-B11","doi-asserted-by":"crossref","first-page":"6062","DOI":"10.19102\/icrm.2024.15104","article-title":"Implantation of an extravascular implantable defibrillator using a substernal lead in a patient with previous cardiac 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