S-ICDs: advantages and opportunities for improvement

ABSTRACT

Introduction

The subcutaneous implantable cardioverter defibrillator (S-ICD) is currently in its third generation and has been adopted in guidelines and in mainstream clinical practice. Considerable improvements have been made since the introduction of this device over a decade ago.

Areas covered

A literature search was undertaken in Pubmed on articles relating to the S-ICD.

Expert opinion

The therapy has been proven to be safe and effective and is a valuable option in selected patients. Nevertheless, there remain many shortcomings of the S-ICD which are discussed in this review, and which hopefully will be addressed by future generations of the device.

KEYWORDS:

• Subcutaneous implantable cardioverter defibrillator
• S-ICD
• implantable cardioverter defibrillator
• CIED
• cardiac implantable electronic device

Article highlights

• The S-ICD has been available since over a decade and is currently in its third generation. It has gained acceptance in international guidelines and has been adopted in mainstream clinical practise.

• The therapy is of interest in patients who do not require antibradycardia pacing or resynchronization therapy, are unlikely to benefit from ATP, have issues with venous access or the tricuspid valve (e.g. prosthesis), or are at risk for infection.

• Shock efficacy is comparable to that of TV-ICDs, but painless ATP is currently not available.

• Rate of inappropriate shocks has been significantly reduced and is comparable to that of TV-ICDs, thanks to better programming and improvements in signal processing.

• There remain however a number of shortcomings, which hopefully will be addressed by upcoming generations of the device (e.g. absence of a monitoring zone, limited diagnostic features, programming and troubleshooting options, unusual programming interfaces, etc.).

• The advent of the EMPOWER leadless pacemaer will allow coupling with the S-ICD, thereby providing an option for ATP and backup pacing.

Declaration of interest

H Burri reports institutional fellowship support/research grants, or consultancy/speaker fees from Abbot, Biotronik, Boston Scientific, Medtronic and Microport. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

One peer reviewer is a consultant for Boston Scientific. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.