Subcutaneous implantable cardioverter defibrillators
- Jonathan Weinstock, MD, FACC, FHRS
Jonathan Weinstock, MD, FACC, FHRS
- Assistant Professor of Medicine
- Tufts University School of Medicine
- Jeffrey Selan, MD
Jeffrey Selan, MD
- Cardiology Fellow
- The Mount Sinai Hospital
- Arjun Majithia, MD
Arjun Majithia, MD
- Department of Cardiovascular Medicine
- Lahey Clinic, Burlington, MA
- Section Editors
- Samuel Lévy, MD
Samuel Lévy, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Cardiology
- University of Marseille, France
- Bradley P Knight, MD, FACC
Bradley P Knight, MD, FACC
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
Sudden cardiac death (SCD) resulting from cardiac arrhythmia is the world's leading cause of cardiovascular mortality, accounting for over 50 percent of cardiovascular deaths worldwide . Implantable cardioverter defibrillators (ICDs) have been shown in numerous large clinical trials to reduce mortality from SCD in selected populations [2-6].
ICD systems consist of a pulse generator, typically placed in the pectoral region, and one or more leads which attach the pulse generator to the heart, most commonly to the endocardium via transvenous insertion (in rare circumstances epicardial leads can be used, but these require a thoracotomy and are typically only used if transvenous lead placement is no longer an option). However, conventional transvenous ICD (TV-ICD) systems come with the inherent drawbacks of transvenous leads, including:
●Risks at the time of insertion – Cardiac perforation, pericardial effusion, cardiac tamponade, hemothorax, pneumothorax (see "Cardiac implantable electronic devices: Peri-procedural complications")
●Delayed risks over the lifetime of the device – Intravascular lead infection, lead failure (see "Cardiac implantable electronic devices: Long-term complications")
Reports of complications at the time of TV-ICD range from 3 to 6 percent of implants. In addition, the delayed risks of transvenous leads include a risk of infection (incidence of 9 per 1000 device-years) and lead failure (ranging from 5 to 40 percent of leads at five years depending on the type of lead), both of which lead to repeat procedures and increased morbidity for patients. (See "Infections involving cardiac implantable electronic devices", section on 'Epidemiology'.)
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- S-ICD COMPONENTS AND CAPABILITIES
- INDICATIONS, CONTRAINDICATIONS, AND AN APPROACH TO SELECTING THE S-ICD
- When to consider the S-ICD
- When to avoid the S-ICD
- Approach to S-ICD device selection
- S-ICD EFFICACY
- POTENTIAL COMPLICATIONS
- COMPARISON WITH TV-ICD
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS