X-Ray Chest - Identify this device

Can you identify the Device by looking at this Chest X-Ray? What can it be based on the location of the pocket and the lead?

If you are having problems identifying the device and the lead, have a look at the image below:

The Orange arrow points towards the Device, the Red arrow points to the lead, the green to the electrodes and yellow one points to the coil. The device, you see is quite big and there is only one lead and then there is a big coil; it is undoubtedly an ICD device.

It is actually a Subcutaneous ICD device. These devices are larger than traditional ICDs and the lead is actually placed under the skin, over the sternum, instead of inside the heart. Fluoroscopy is not required for the procedure and the complications of venous access are averted.

They do have their downsides: the size of the device is larger and so is the pocket required and the battery life is half of that for traditional devices.

It is particularly useful in pediatrics, in those with previous history of endocarditis or in high risk patients.

Here is a video explaining the implantation procedure:

Further reading:

http://circ.ahajournals.org/

https://www.escardio.org/

https://www.mayoclinic.org/