Opportunities and drawbacks of the subcutaneous defibrillator across different clinical settings

ABSTRACT

Introduction

The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an established therapy for the prevention of sudden cardiac death (SCD) and an alternative to a transvenous implantable cardioverter-defibrillator system in selected patients. Beyond randomized clinical trials, many observational studies have described the clinical performance of S-ICD across different subgroups of patients.

Areas covered

Our review aimed to describe the opportunities and drawbacks of the S-ICD, focusing on their use in special populations and across different clinical settings.

Expert opinion

The choice to implant S-ICD should be based on the patient’s tailored approach, which takes into account the adequate S-ICD screening at rest or during stress, the infective risk, the ventricular arrhythmia susceptibility, the progressive nature of the underlying disease, the work or sports activity, and the risk of lead-related complications.

KEYWORDS:

• Subcutaneous implantable cardioverter-defibrillator
• sudden cardiac death
• inappropriate shock
• lead-related complications
• cardiomyopathy
• work activity
• sports activity
• psychosocial issues

Article highlights

• S-ICD is non-inferior to TV-ICD for device-related complications or inappropriate shocks.

• S-ICD should be considered when pacing therapy for bradycardia support, cardiac resynchronization, or anti-tachycardia pacing is not needed.

• S-ICD may be considered when venous access is difficult, after the removal of a transvenous ICD for infections in young patients with a long-term need for ICD therapy.

• The choice to implant S-ICD should be based on the patient’s tailored approach, which takes into account several factors.

• An appropriate patient selection and screening alongside contemporary device programming are paramount to the success of S-ICD therapy.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

A peer reviewer on this manuscript is P.I. on a trial involving SICD (EMPOWER-modular ATP) and has received research funding from Boston Scientific. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded