Why the study?
While the S-ICD avoids TV-ICD risks, it has unique limitations and was historically used in younger patients with fewer comorbidities, warranting an updated review of recent literature including the UNTOUCHED and PRAETORIAN trials.
Does the subcutaneous ICD (S-ICD) provide noninferior complication rates and effective arrhythmia conversion compared to transvenous ICDs?
Does the subcutaneous ICD (S-ICD) provide noninferior complication rates and effective arrhythmia conversion compared to transvenous ICDs?
S-ICDs are a viable alternative to transvenous ICDs with noninferior complication rates and excellent arrhythmia conversion, though careful patient selection and screening are required to minimize oversensing.
The ICD is an important part of the treatment and prevention of sudden cardiac death in many high-risk populations. Traditional transvenous ICDs (TV-ICDs) are associated with certain short- and long- term risks. The subcutaneous ICD (S-ICD) was developed in order to avoid these risks and complications. However, this system is associated with its own set of limitations and complications. First, patient selection is important, as S-ICDs do not provide pacing therapy currently. Second, pre-procedural screening is important to minimise T wave and myopotential oversensing. Finally, until recently, the S-ICD was primarily used in younger patients with fewer co-morbidities and less structural heart disease, limiting the general applicability of the device. S-ICDs achieve excellent rates of arrhythmia conversion and have demonstrated noninferiority to TV-ICDs in terms of complication rates in real-world studies. The objective of this review is to discuss the latest literature, including the UNTOUCHED and PRAETORIAN trials, and to address the risk of inappropriate shocks.
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Karimianpour et al. (2021) studied this question.
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