The Entirely Subcutaneous Defibrillator (S-Icd): State of the Art and Selection of the Ideal Candidate

Abstract

The traditional transvenous defibrillator has been one of the greatest advancement in Cardiology in the last 30 years and has demonstrated to reduce arrhythmic and total mortality in selected patients. However the traditional defibrillator can have a high price to pay in terms of complications, the “weakest link” being the transvenous/endocardial leads. The entirely subcutaneous defibrillator (S-ICD) has recently entered into the clinical scenario and represents a valid alternative to the transvenous device. S-ICD can provide substantial advantages, especially among some subgroups of patients (i.e. after device infection, in young patients and arrhythmogenic syndromes). However, given its characteristics, it is fundamental to choose patients that can benefit the most. In this review we will describe advantages and limitations of the S-ICD and point-out how to select the “ideal candidate” for the implantation.

J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge

“…304 Sub-cutaneous ICDs are thought to represent the future for this indication in that they are expected to be associated with fewer complications over a lifetime. 305 …”

J wave syndromes as a cause of malignant cardiac arrhythmias

“…Remote monitoring can identify lead failure and prevent inappropriate shocks . The advent of subcutaneous ICDs is a welcome innovation associated with fewer complications over a lifetime …”

Heart Failure, Introduction

“…This measurement combined with a physician-directed patient selfmanagement program resulted in decreased hospitalizations and mortality. Newer methods of placing ICDs subcutaneously, as opposed to endovascular, have not changed outcomes but allow for better options in select patients, such as those with history of device infection and end-stage renal disease patients needing venous dialysis access [ 27 ].…”