ExtraVascular Implantable Cardioverter Defibrillator (EV ICD) Japan Study

• Patient has a Class I or IIa indication for implantation of an ICD according to the ACC/AHA/HRS Guidelines [i], or ESC guidelines [ii].
• Patient is at least 18 years of age and meets age requirements per local law.

• Patient is geographically stable and willing and able to complete the study procedures and visits for the duration of the follow-up.

  [i] Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Hlatky MA, Granger CB, Hammill SC, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias. [ii] Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliot PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekval TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal 2015 36:41 (2793-2867). https://doi.org/10.1093/eurheartj/ehv316

Exclusion Criteria:

• Patient is unwilling or unable to personally provide Informed Consent.
• Patient has indications for bradycardia pacing [iii] or Cardiac Resynchronization Therapy (CRT) [iv] (Class I, IIa, or IIb indication).
• Patient with an existing pacemaker, ICD, or CRT device implant or leads.

• Patients with these medical interventions are excluded from participation in the study:

  • Prior sternotomy
  • Any prior medical condition or procedure that leads to adhesions in the anterior mediastinal space (i.e., prior mediastinal instrumentation, mediastinitis)
  • Prior abdominal surgery in the epigastric region
  • Planned sternotomy
  • Prior chest radiotherapy

Or any other prior/planned medical intervention not listed that precludes their participation in the opinion of the Investigator.

• Patient has previous pericarditis that:

  • Was chronic and recurrent, or
  • Resulted in pericardial effusion [v], or
  • Resulted in pericardial thickening or calcification [vi].

• Patients with these medical conditions or anatomies are excluded from participation in the study:

  • Hiatal hernia that distorts mediastinal anatomy
  • Marked sternal abnormality (e.g., pectus excavatum)
  • Decompensated heart failure
  • COPD with oxygen dependence
  • Gross hepatosplenomegaly Or any other known medical condition or anatomy type not listed that precludes their participation in the opinion of the Investigator.

• Patients with a medical condition that precludes them from undergoing defibrillation testing:

  • Severe aortic stenosis
  • Intracardiac LA or LV thrombus
  • Severe proximal three-vessel or left main coronary artery disease without revascularization
  • Hemodynamic instability
  • Unstable angina
  • Recent stroke or transient ischemic attack (within the last 6 months)
  • Known inadequate external defibrillation
  • LVEF \<20%
  • LVEDD >70 mm Or any other known medical condition not listed that precludes their participation in the opinion of the Investigator.
• Patient with any evidence of active infection or undergoing treatment for an infection.
• Patient is contraindicated from temporary suspension of oral/systemic anticoagulation
• Patient with current implantation of neurostimulator or any other chronically implanted device that delivers current in the body.
• Patient meets ACC/AHA/HRS or ESC clinical guideline Class III criteria for an ICD (e.g., life expectancy of less than 12 months).
• Patient is enrolled or planning to enroll in a concurrent clinical study that may confound the results of this study, without documented pre-approval from a Medtronic study manager.
• Patient with any exclusion criteria as required by local law (e.g., age or other).
• Pregnant women or breastfeeding women, or women of child bearing potential and who are not on a reliable form of birth regulation method or abstinence.

[iii] 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing). [iv] ACC/AHA/HRS guidelines for Cardiac Resynchronization Therapy. [v] As documented on echo or MRI. [vi] As documented on CT scan or MRI.