Left inferior phrenic vein ICD lead implantation

Transvenous implantable cardioverter (ICD) leads in the typical right ventricular apical position are ideally avoided in patients with prior tricuspid valve repair surgery or significant tricuspid regurgitation.1 Alternative lead placement techniques have been described, with leads placed in the coronary sinus (CS) body, middle cardiac vein (MCV), azygous vein, or surgically on the epicardium. More recently, the options of subcutaneous ICDs and substernal ICDs have provided a promising alternative in such patients.