Totally submuscular implantation of subcutaneous implantable cardioverter defibrillator: a safe and effective solution for obese or oversized patients

Key Clinical Message The subcutaneous implantable cardioverter–defibrillator (S-ICD) is a safe alternative to transvenous ICD. We describe a submuscular S-ICD placement technique in a severely obese with an oversized chest. Submuscular configuration allows optimal system positioning and impendence values warranting a safe and effective shock transmission. This technique is safe and improves patients comfort.