Subcutaneous implantable cardioverter defibrillator: Where do we stand?

Abstract

The indications for implantable cardioverter defibrillators (ICDs) for the prevention of sudden cardiac death (SCD) have rapidly expanded over the past 15 years. Clinical trial data have quickly been implemented into guidelines. The recently introduced subcutaneous implantable cardioverter defibrillator (S-ICD) uses a completely subcutaneous electrode configuration to treat potentially lethal ventricular tachyarrhythmia. The device is now commercially available in India. Clinical trials have proven its effectiveness in detecting and treating ventricular fibrillation (VF) and tachycardia. The S-ICD offers the advantage of eliminating the need for intravenous and intracardiac leads and their associated risks and shortcomings. However, major disadvantages of this device include inability to provide bradycardia rate support and antitachycardia pacing to terminate ventricular tachycardia. As seen with other early examples of evolutionary technology, we hope improvements in design and manufacture will improve some of the drawbacks of the current generation device.

Keywords

• Implantable cardioverter defibrillator
• subcutaneous
• sudden cardiac death