Subcutaneous implantable cardioverter-defibrillator placement in a patient with a preexisting transvenous implantable cardioverter-defibrillator

Introduction The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a safe and effective treatment for prevention of sudden cardiac death. It is typically not used in patients who require additional therapies conferred by transvenous implantable cardioverter-defibrillator (TV-ICD) systems, such as bradycardia pacing or antitachycardia pacing (ATP) for ventricular tachycardia (VT). Despite reports of successful S-ICD implantation in patients with other cardiac implantable electronic devices (CIEDs), we are not aware of any reports to date in which S-ICD implantation complemented a pre-existing TV-ICD as a backup device for successful defibrillation. We report the case of a patient who presented with this clinical dilemma.