The subcutaneous implantable cardioverter and defibrillator: advantages, limitations and future directions

Abstract

The totally subcutaneous implantable cardioverter and defibrillator (S-ICD) represents the most innovative development in implantable cardioverter and defibrillator therapy in the last 15 years. Its development arose out of concern for the long-term complications of transvenous devices. Clinical trials have shown that it is a safe and effective device for patients at risk of sudden cardiac death. The lack of transvenous and intracardiac components makes it an attractive choice for young patients, those with limited vascular access and increased infectious risk. Despite these advantages, the current S-ICD system has limitations, including the inability to deliver cardiac pacing. Future programming and technologic advancements have the opportunity to dramatically improve the efficacy and broaden the patient population treated with the S-ICD.

Keywords:

• cardiac arrest
• subcutaneous implantable cardioverter and defibrillator
• sudden cardiac death
• transvenous implantable cardioverter and defibrillator

Financial & competing interests disclosure

BP Knight is a consultant for Boston Scientific, Inc., the manufacturer of the subcutaneous implantable defibrillator. 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.

Key issues

• Implantable cardioverter and defibrillator technology and indications for use have progressed rapidly over the past few decades.

• The subcutaneous implantable cardioverter and defibrillator (S-ICD) is the most innovative development in implantable cardioverter and defibrillator therapy in the past 15 years. It evolved out of concern for the long-term risks associated with transvenous device placement.

• Clinical studies have demonstrated that the S-ICD is a safe and effective option for patients at risk of sudden cardiac death.

• Advantages of a totally subcutaneous system include the lack of intracardiac and transvenous components, thereby decreasing the immediate risks and mitigating potential long-term complications.

• The S-ICD design makes it an attractive choice for younger patients, especially those with genetic arrhythmic syndromes, those with vascular access issues and increased infectious risk.

• Despite these potential advantages, the device is large, has no pacing and has a rate of infection and inappropriate shocks on par with traditional devices.

• Future programming changes and technologic advancements have the potential to dramatically improve the efficacy and indications for the S-ICD.

Notes