Subcutaneous implantable defibrillator: State-of-the art 2013

Abstract

The subcutaneous implantable cardioverter-defibrillator (S-ICD) has recently been approved for commercial use in Europe, New Zealand and the United States. It is comprised of a pulse generator, placed subcutaneously in a left lateral position, and a parasternal subcutaneous lead-electrode with two sensing electrodes separated by a shocking coil. Being an entirely subcutaneous system it avoids important periprocedural and long-term complications associated with transvenous implantable cardioverter-defibrillator (TV-ICD) systems as well as the need for fluoroscopy during implant surgery. Suitable candidates include pediatric patients with congenital heart disease that limits intracavitary lead placements, those with obstructed venous access, chronic indwelling catheters or high infection risk, as well as young patients with electrical heart disease (e.g., Brugada Syndrome, long QT syndrome, and hypertrophic cardiomyopathy). Nevertheless, given the absence of intracavitary leads, the S-ICD is unable to offer pacing (apart from short-term post-shock pacing). It is therefore not suitable in patients with an indication for antibradycardia pacing or cardiac resynchronization therapy, or with a history of repetitive monomorphic ventricular tachycardia that would benefit from antitachycardia pacing. Current data from initial clinical studies and post-commercialization "real-life" case series, including over 700 patients, have so far been promising and shown that the S-ICD successfully converts induced and spontaneous ventricular tachycardia/ventricular fibrillation episodes with associated complication and inappropriate shock rates similar to that of TV-ICDs. Furthermore, by using far-field electrograms better tachyarrhythmia discrimination when compared to TV-ICDs has been reported. Future results from ongoing clinical studies will determine the S-ICD system's long-term performance, and better define suitable patient profiles.

Implantation of the Subcutaneous Implantable Defibrillator S-ICDTM: Initial Experience in a Single Spanish Center

“…To avoid these problems, a completely subcutaneous defibrillation system has been developed. 1 Nonetheless, this device was introduced only recently in Spain 2 and current experience is limited. The subcutaneous ICD has 2 main components, a pulse generator (S-ICD TM , SQ-RX 1010, Boston Scientific) that weighs 145 g, has an estimated longevity of 5 years, and delivers 80-J shocks with up to 30 seconds of postshock pacing, and a lead (Q-Trak 3010, Boston Scientific) for detection and defibrillation.…”

Pocket infection as a complication of a subcutaneous implantable cardioverter-defibrillator

“…In the emerging scenario of concomitant problems and diseases [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67], the S-ICD can provide clinical advantages in patients undergoing possible complications and in those with limited intracavitary lead placements, chronic indwelling catheters, obstructed venous access and in young patients avoiding the need for electrodes within the heart [23][24][25]. Complications are always possible, such as pocket and system infections, lead dislodgement, suboptimal position, lead dislodgement, oversensing, inappropriate shock and premature battery depletion but the new alternative technique of s-ICD represents an important innovation in the field of device therapy [23,68,69]. We describe the case of a pocket infection of a S-ICD (Figs.…”

A subcutaneous finger cardioverter-defibrillator system removal under local anesthesia

“…The evolution of devices in serious cardiac rhythm pathology management has led progressively to the development of devices for the treatment of bradycardia, ventricular arrhythmia, and heart failure and for the prevention of sudden cardiac arrest leading to delivery of pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) plus ICD (CRT-D) and to the recent subcutaneous implantable cardioverter-defibrillator (S-ICD) [23][24][25][26][27]. Infectious complications leading also to endocarditis [1,8,[28][29][30][31][32][33][34][35] and non-infectious complications [9,21,23,[36][37][38][39] often necessitating removal [1,2,8,[39][40][41][42][43][44][45] affect patient wellbeing also leading to psychological difficulty increase [46][47][48][49][50][51][52] in the emerging scenario of concomitant problems and diseases .…”