Subcutaneous ICD after heart transplantation due to idiopathic fatal arrhythmias in the donor: a first experience

The ongoing global shortage of donor hearts dictates the need for innovative solutions to enlarge the donor pool and to reduce mortality of patients on the waiting list. The extended-heart-transplantation-criteria premise is to match patients who fall outside traditional eligibility criteria with donor hearts that have high risk features. In our case, the donor experienced ventricular fibrillation episodes. Given the idiopathic arrhythmogenic substrate of the transplanted heart, we decided to protect the receiver with a subcutaneous implantable cardioverter defibrillator in the short-term post heart transplantation. It represents the first experience worldwide in this specific setting of sudden cardiac death.