The subcutaneous ICD for prevention of sudden cardiac death: Current evidence and future directions

Abstract

Despite major advances in medical therapy, sudden cardiac death remains an important cause of cardiovascular mortality. In order to improve the risk‐benefit balance of transvenous implantable cardioverter‐defibrillator (ICD) systems, a totally subcutaneous ICD (S‐ICD) system was developed and approved for use in Europe in 2009. The currently available S‐ICD system has undergone several important hardware‐ and software‐related modifications and improvements over the last 10 years aimed at further improving its efficacy and safety. The results of the PRAETORIAN trial, that is, the first randomized comparison of S‐ICD versus transvenous ICDs, of the prospective UNTOUCHED study, and the overall consistent observational data underline that current generation S‐ICD systems may be a valid alternative in patients with an ICD indication in whom bradycardia pacing or cardiac resynchronization therapy is not required due to a lower risk of system‐related problems. This review summarizes the key differences between the two systems, improvements in hardware components and algorithms over time, as well as most recent clinical evidence regarding the efficacy and safety of the S‐ICD.

Systemic Brucellosis with Arrhythmogenic Cardiac Inflammatory Pseudotumor

“…As the patient did not require permanent pacing and, bearing in mind that over the course of a 3-month in-hospital observation she had no VT recurrence, a subcutaneous device was chosen instead of a transvenous system. Disadvantages of S-ICD systems include the inability to provide antitachycardia pacing in case of monomorphic VT; however, by not implanting the defibrillation lead into the right ventricle, we avoided its possible harmful interaction with the injured myocardium [ 14 ]. Other possible options could be a wearable cardioverter-defibrillator but taking into account observations of recurrences of brucellosis, we decided that permanent protection with the implantable device might be a better option.…”

Importância da Técnica Anestésica e Analgesia no Implante de Desfibrilador Subcutâneo e Endovascular: Um Aspecto Geralmente Ignorado

“…1 This technique is rapidly evolving to become a safe and effective alternative for the TV-ICD, leaving the heart and vasculature untouched, with reduced lead-related complications. [1][2][3][4][5] New interventions and devices necessarily demand a constant analysis of the appropriate anesthetic technique to be used. Only recently, the first studies that deal with the implantation of S-ICD have appeared and analyzed the issue of perioperative safety and postoperative analgesia, as well as its impact on the patient.…”