Concomitant use of the novel extravascular implantable cardioverter-defibrillator with an epicardial pacemaker

The EV-ICD is a novel defibrillator with its lead placed substernally in the anterior mediastinum. Due to limited pacing capabilities, patients requiring permanent stimulation are typically better suited for a transvenous defibrillator. However, in cases where this is not feasible (such as ongoing systemic infection) alternatives must be considered. We present a case where an EV-ICD was combined with an epicardial pacemaker to provide both defibrillation and pacing, while avoiding transvenous implantation.