Long title: Preservation of an Extravascular Implantable Cardioverter-Defibrillator during sternotomy and surgical myectomy.

Key Teaching Points Extravascular cardioverter defibrillator (EV-ICD) leads sit underneath the sternum in the sub-sternal space.To the authors knowledge we are the first to describe the successful preservation of an EV-ICD during a sternotomy, with proven successful defibrillator therapy following the surgical recovery period. We contrast the strengths and limitations of the EV-ICDs novel system against transvenous and subcutaneous alternatives, particularly in younger patients who are at higher risk of cumulative transvenous complications. These findings suggest that EV-ICDs may be a suitable option in arrhythmic patients who may require future cardiac surgery.