The subcutaneous implantable cardioverter-defibrillator

Abstract

The SICD provides a useful alternative for high-energy (ICD) therapy in those deemed at risk and who need defibrillation and in whom there are no indications for cardiac resynchronization, bradycardia support or antitachycardia pacing. There is the possibility of both higher specificity and the avoidance of myo-cellular damage with shock delivery, and if these two aspects play out subcutaneous defibrillation could become an option of choice in many settings.

Initial experience with the subcutaneous implantable cardioverter-defibrillator with the real costs of hospitalization analysis in a single Polish center

“…It becomes a less invasive option for patients in whom TV-ICD implantation is surgically impossible. It is estimated that up to 55% of patients in routine clinical practice needing an ICD are potential candidates for a subcutaneous device [14,15]. However, to maximize clinical outcome and cost/benefit ratio, it is fundamental to choose candidates that can benefit most, taking into account both patient and device characteristics.…”

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

“…The development of this device was initially motivated by peculiar cases, such as pediatric population with congenital heart diseases or patients with no venous access who were unsuitable for transvenous ICD [9, 10, 11, 13]. …”

“…previous device infection, hemodialysis, chronic immunosuppression therapy, immunodeficiencies, artificial heart valves etc) [9, 13]. Pocket infections can occur with the S-ICD (between 5 and 10%, not so different compared to transvenous devices), but a striking observation is that the resolution of the infection with antibiotic therapy is possible in the majority of cases, without explantation of the system [9, 10, 19]. Even when explantation becomes necessary, it represents a much more simple and safer procedure compared to endovascular lead extraction; this is particularly important in young patients with a long life expectancy and high lead failure rate due to active lifestyles [9, 10, 11].…”

“…The simplified implant procedure, without the need for fluoroscopy, is another advantage: it could be a reason for a more widespread use of a life-saving therapy, even in those centers without a great experience in traditional surgical procedure, with less risk of serious complications [9, 10, 11]. …”

“…“When lead failures occur, transvenous lead extraction may be necessary: this procedure is highly challenging with major complications rates of about 1% and a mortality risk of 0.3% also in experienced centers” [6-9]. In the context of this clinical background the entirely subcutaneous defibrillator (S-ICD) has entered into the clinical scenario [10, 11]. …”