Sudden cardiac death is the leading cause of mortality in adults with complex congenital heart disease. Challenges to implanting cardioverter-defibrillators (ICDs) may arise as a result of vascular or intracardiac access issues. For example, conduits may divert systemic venous return to extracardiac structures such as pulmonary arteries or tunnels. Creative approaches to ICD implantation have previously involved subcutaneous arrays, often associated with thoracotomy to implant intrathoracic coils. We describe a patient with complex congenital heart disease and no transvenous access via the superior vena cava in whom ICD implantation involved placement of a coil within the azygos vein.
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