Key result
S-ICD achieves ~98% shock conversion and low complications, proving noninferior to transvenous ICDs.
Why the study?
Defibrillator treatment aims to prevent sudden cardiac death while minimizing complications by using extrathoracic systems to eliminate intracardiac leads.
Does the subcutaneous implantable cardioverter-defibrillator (S-ICD) prevent sudden cardiac death while reducing lead-related complications and systemic infections compared to transvenous ICDs in patients without pacing indications?
Does the subcutaneous implantable cardioverter-defibrillator (S-ICD) prevent sudden cardiac death while reducing lead-related complications and systemic infections compared to transvenous ICDs in patients without pacing indications?
The S-ICD should be considered a routine clinical option for sudden cardiac death prevention in patients without pacing indications, as it effectively terminates arrhythmias while avoiding the long-term risks of transvenous leads.
Supports S-ICD consideration to reduce lead complications; leaves open definitive long-term superiority data from randomized trials.
Defibrillator treatment should adhere to the guidelines to effectively prevent sudden cardiac death while minimizing all complications. As an entirely extrathoracic system, the subcutaneous implantable cardioverter defibrillator (S-ICD) eliminates the need for intracardiac leads, thus reducing procedural and lead-related complications as well as systemic infections. The evidence across > 5000 participants in randomized trials and registries demonstrates approximately 98% shock conversion with low complication rates. The PRAETORIAN study demonstrated that the S‑ICD is not inferior to the transvenous ICD (TV-ICD), long-term and secondary analyses indicate fewer severe, particularly lead-related, complications with S‑ICD treatment. Studies such as UNTOUCHED, EFFORTLESS, and PAS confirm its shock effectiveness and safety profile in routine clinical care, while the ATLAS study reports significantly fewer perioperative lead-related complications in younger patients. The procedure has been streamlined and standardized, incorporating best practices such as preoperative vector screening, a two-incision technique, intermuscular/submuscular pocket creation, and dual-zone programming with morphology/high-pass filtering. In the absence of indications for bradypacing, cardiac resynchronization therapy (CRT) or antitachycardia pacing (ATP), the S‑ICD should be considered a routine option in the clinical routine, especially for younger patients, those prone to infections, those with limited venous access and individuals with hereditary arrhythmia syndromes.
No takes yet. Share an insight, caveat, or question.
Kuschyk et al. (2025) conducted a review in Sudden cardiac death prevention (n=5,000). Subcutaneous implantable cardioverter defibrillator (S-ICD) vs. Transvenous ICD (TV-ICD) was evaluated on Shock conversion. The subcutaneous implantable cardioverter defibrillator (S-ICD) demonstrates approximately 98% shock conversion with low complication rates and is noninferior to transvenous ICDs.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: