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  • Review Article
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Clinical experience with subcutaneous implantable cardioverter-defibrillators

Nature Reviews Cardiology volume 12, pages 398–405 (2015)Cite this article

Subjects

Key Points

  • Implantable cardioverter-defibrillators (ICDs) reduce mortality in patients with increased risk of sudden cardiac death, but use of these devices has been limited by complications with the intravascular leads

  • The subcutaneous ICD (S-ICD) is a new ICD device that avoids placing leads in the cardiac vascular system

  • The S-ICD is safe and effective for the treatment of ventricular tachycarrhythmias, but use of S-ICDs is limited by the lack of pacing or remote monitoring capabilities

  • The S-ICD is most commonly used in young patients at risk for ventricular fibrillation, but not ventricular tachycardia, and without pacing indications

  • Future generations of the S-ICD should allow for expanded use and for subcutaneous leads to be combined with leadless pacing, enabling the S-ICD to become the standard ICD device

Abstract

The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a novel technology for the treatment of sudden cardiac death. The system consists of a pulse generator implanted in the left axillary position and a single subcutaneous lead for detection and delivery of therapy. Initial clinical trials of S-ICDs demonstrated improved safety and efficacy when compared to transvenous ICD systems, leading to their widespread approval. The main advantage of the S-ICD is the avoidance of vascular access and the complications associated with transvenous leads. Owing to limitations of S-ICDs, patients who require pacing support or antitachycardia pacing are not candidates for the device; instead, this system is currently used most commonly in young patients with previous lead malfunction, limited vascular access, or low risk for subsequent bradycardia or antitachycardia pacing. Findings from device trials support S-ICDs as a viable alternative to transvenous ICDs in certain patients, and the current limitations associated with S-ICDs are likely to be addressed in future iterations of the device, extending its indications and target patient populations.

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Figure 1: Comparison between a S-ICD and a transvenous ICD.
Figure 2: Location of S-ICD components and possible sensing vectors.

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Author information

Authors and Affiliations

  1. Division of Cardiology, Medical University of South Carolina, 114 Doughty Street, MSC 592, Charleston, 29425-5920, SC, USA

    Geoffrey F. Lewis & Michael R. Gold

Authors
  1. Geoffrey F. Lewis
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  2. Michael R. Gold
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Contributions

Both authors researched data for the article, discussed its content, and wrote, reviewed, and edited the manuscript before submission.

Corresponding author

Correspondence to Michael R. Gold.

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Competing interests

M.R.G. has received consulting fees and performed clinical trials with Boston Scientific, Medtronic and St Jude. G.F.L. declares no competing interests

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Lewis, G., Gold, M. Clinical experience with subcutaneous implantable cardioverter-defibrillators. Nat Rev Cardiol 12, 398–405 (2015). https://doi.org/10.1038/nrcardio.2015.56

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