Rise in defibrillation threshold after postoperative cardiac remodeling in a patient with severe Ebstein’s anomaly Reina Bianca Tan, MD, Charles Love,

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Rise in defibrillation threshold after postoperative cardiac remodeling in a patient with severe Ebstein’s anomaly Reina Bianca Tan, MD, Charles Love, MD, FHRS, Dan Halpern, MD, Frank Cecchin, MD HeartRhythm Case Reports Volume 3, Issue 6, Pages 302-305 (June 2017) DOI: 10.1016/j.hrcr.2017.03.007 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 A: Preoperative cardiac magnetic resonance image of the heart. Center of myocardial mass is depicted as the center of an oblong around the myocardium and located at the midpoint of the left hemithorax. Severely dilated right atrium (RA) and right ventricle (RV) with posterior displacement of left ventricle (LV). B: Computerized tomography image of the heart 2 months post repair. Decreased RV size with re-expansion of left lung. The center of myocardial mass is shifted anteromedially compared to preoperative scan. eLV = epicardial left ventricular lead; SC = subcutaneous coil. HeartRhythm Case Reports 2017 3, 302-305DOI: (10.1016/j.hrcr.2017.03.007) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 A: Early postoperative chest radiograph with an epicardial superior vena cava lead (eSVC), posterior epicardial left ventricular lead (eLV), subcutaneous array around the left hemithorax, and an abdominal generator. B: Chest radiograph 2 months post repair with decrease in heart size and re-expansion of left lower lung with relative shift of subcutaneous coil in relation to the heart. C: Chest radiograph post revision with stable epicardial SVC lead and posterior eLV lead and subcutaneous array around the anterior and left hemithorax. A = atrial lead; SC = subcutaneous coil; V = ventricular lead. HeartRhythm Case Reports 2017 3, 302-305DOI: (10.1016/j.hrcr.2017.03.007) Copyright © 2017 Heart Rhythm Society Terms and Conditions