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The subcutaneous ICD (S-ICD) is a viable alternative to transvenous ICD and avoids intravascular complications in patients without a pacing indication. The outcomes of S-ICD implantation are uncertain in patients with prior sternotomy.We aim to compare the implant techniques and outcomes with S-ICD implantation in patients with and without prior sternotomy.Multicenter retrospective cohort study including adult patients with an S-ICD implanted between January 2014 and June 2020. Outcomes were compared between patients with and without prior sternotomy.Among the 212 patients (49 ± 15 years old, 43% women, BMI 30 ± 8 kg/mImplantation of an S-ICD in patients with prior sternotomy is safe with a similar risk of 30-day complications and inappropriate ICD shocks as patients without prior sternotomy.

Many techniques exist for venous access (VA) during cardiac implantable electronic device (CIED) implantation.We sought to evaluate the learning curve with ultrasound (US) guided axillary vein access (USAA).Single-center prospective randomized controlled trial of patients undergoing CIED implantation. Patients were randomized in a 2:1 fashion to USAA versus conventional VA techniques. The primary outcomes were the success rates, VA times and 30-day complication rates.The study included 100 patients (age 68 ± 14 years, BMI 27 ± 4 kg/mAlthough the success rate with USAA was high, there was a significant learning curve. Once experienced with the USAA technique, there is the potential for reduced complications without adding to the procedure duration.