Extravascular implantable cardioverter-defibrillator implantation in a patient with nickel and cobalt allergies

As global implantation rates for Cardiac Implantable Electronic Devices (CIEDs) exceed 1 million a year (1,2), the number of rare complications including device hypersensitivity has increased. CIED-hypersensitivity reactions (CIED-HSRs) to pacemakers and implantable cardioverter defibrillators (ICDs) are difficult to diagnose as they share a similar presentation as CIED-infection and skin patch testing suffers from low sensitivity (3). Primary and secondary prevention of device reactions involves the utilization of hypoallergenic device components or coatings such as gold, polytetrafluoroethylene (PTFE), and silicone to protect against metal leach.