SICD Implantation Technique
For SICD device implantation, patients were placed in a supine position
on the surgical table, with the left arm in an abducted position on an
arm rest. There were three incisions made in total (Fig 1): left
parasternal, sub-xiphoid in the midsagittal line, and inframammary along
the anterior axillary line. The device was situated between the anatomic
space between the serratus anterior and the latissimus dorsi muscles at
the T 5-6 level. The distal tip of the electrode insertion tool was
inserted at the xiphoid and tunneled laterally until the distal tip
emerged in the device pocket. The electrode then was connected to the
generator. The generator was fixed in the pocket with two separate
sutures between the muscular fascia and the anchoring hole. The xiphoid
incision site was also used to tunnel the lead cranially to reach the
parasternal incision higher in the chest.