Leadless pacing and non-transvenous defibrillation options are attractive alternatives for patients requiring pacing or defibrillation systems at high-risk of or having already experienced lead-related complications. However, current available systems offer a limited range of therapies. Patients who need simultaneous pacing therapy, especially atrial pacing, and anti-tachycardia pacing (ATP) therapies as well are not eligible for these new technologies. In this case series, we describe the first two patients in whom an Aurora extravascular-ICD (EV-ICD, Medtronic, MN, USA) and Aveir AR atrial leadless pacemaker (Abbott Medical, IL, USA) were implanted in combination.

Antero-septal intramural scar in nonischemic cardiomyopathy is one of the most challenging substrates to modify with radiofrequency catheter ablation for ventricular tachycardia (VT).1,2 Bipolar ablation has been reported as a bail-out treatment option for intramural substrates due to a transmural lesion creation.3,4 On the other hand, an effective radiofrequency delivery from an anatomical structure distinct from but adjacent to the earliest activation site of a ventricular arrhythmia has been reported as an anatomical approach.

Infrahepatic interruption of the inferior vena cava (IVC) is a congenital anomaly found in 0.15% of the general population and in 0.6% of patients with congenital heart disease.1,2 Owing to its asymptomatic nature and lack of functional limitations, this anomaly is often detected incidentally during cardiac intervention. Catheter ablation is widely performed using a trans-IVC approach in the right heart. In cases of IVC interruption, alternative approaches, such as the internal jugular, subclavian, and azygos vein approaches, are used.