Inadvertent placement of a subcutaneous defibrillator lead in the anterior mediastinum through a sternal foramen

The subcutaneous implantable cardioverter defibrillator (S-ICD) is designed to be positioned using anatomical landmarks. It is recommended that a pre-implant chest X-ray be undertaken to confirm that there is no notably atypical anatomy. We present the case of a patient who, inadvertently, had a S-ICD lead placed in the anterior mediastinum, due to its passage through a sternal foramen, during an elective implant for primary prevention. This lead was then safely removed under surgical video assisted thoracoscopy guidance.