Fu Wai Hospital Pioneers EV-ICD Implantation: A New Era in Sudden Cardiac Death Prevention

On November 16, 2025, under the direction of Prof. Xiaohan Fan, Associate Director of Arrhythmia Ward 1 at Fu Wai Hospital, the team led by Dr. Xianqing Wang from Arrhythmia Ward 2 successfully implanted an EV-ICD in a 68-year-old high-risk patient. The patient, who had a history of coronary artery disease, prior myocardial infarction, and recurrent malignant ventricular arrhythmias, had previously deferred treatment due to concerns over complications from traditional transvenous ICDs (such as vascular damage, cardiac perforation, and lead infection). The EV-ICD represents a significant technological leap in Sudden Cardiac Death (SCD) prevention. Its innovative design places the defibrillation lead in the extravascular space beneath the sternum, achieving a 'heart-sparing, vessel-sparing' minimally invasive goal. This configuration entirely bypasses the risks associated with transvenous leads while offering comprehensive functionality, including defibrillation, cardioversion, Anti-Tachycardia Pacing (ATP), and bradycardia pacing—addressing the functional limitations of the S-ICD. The Fu Wai team ensured success through thorough pre-operative planning, including detailed chest CT assessment and a multidisciplinary team (MDT) consultation, resulting in a personalized "substernal extravascular lead placement and optimized pocket" approach. The 1.5-hour procedure was smooth. The device successfully terminated induced ventricular fibrillation with a 30-Joule shock and demonstrated effective pacing capability. The EV-ICD, with its revolutionary safety profile, efficacy, and comprehensive features, is ideally suited for elderly patients, those with complex co-morbidities, or those at high risk for traditional ICD complications. This successful implantation not only provides the patient with superior life protection but also demonstrates Fu Wai Hospital's capability to synchronize with international techniques in managing complex arrhythmias and SCD, solidifying its leadership in cardiovascular medicine.