Key result
EV-ICD is linked to ~45 minutes longer procedural time and increased fluoroscopy versus S-ICD.
Why the study?
S-ICD lacks pacing and relies on far-field sensing, whereas EV-ICD introduces a substernal lead providing pacing while avoiding the vasculature, prompting a comparison of their real-world outcomes.
Does EV-ICD improve procedural and short-term clinical outcomes compared to S-ICD in patients requiring extravascular defibrillators?
Cohort (n=30)
No
Does EV-ICD improve procedural and short-term clinical outcomes compared to S-ICD in patients requiring extravascular defibrillators?
Absolute Event Rate: 105% vs 60%
p-value: p=0.005
EV-ICD demonstrates procedural feasibility and safety with added pacing functionality compared to S-ICD, though it requires longer procedural and fluoroscopy times.
EV-ICD implantation prolongs procedure and fluoroscopy times; observational data leave comparative safety open for randomized trials.
Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) provides extravascular protection against sudden cardiac death but lacks pacing and relies on far-field sensing. The newer extravascular ICD (EV-ICD) introduces a substernal lead capable of anti-tachycardia pacing (ATP) and post-shock pacing while avoiding the vasculature. Objective To compare real-world procedural and short-term clinical outcomes between EV-ICD and S-ICD systems in a tertiary cardiac center. Methods This retrospective single-center study analyzed patients who underwent EV-ICD (n = 12) or S-ICD (n = 18) implantation between September 2015 and July 2025. Demographics, procedural parameters, defibrillation testing, complications, shocks, and hospitalization were reviewed. Data were analyzed descriptively and comparatively between both cohorts. Results Mean age was 40 ± 12 years, predominantly male (EV-ICD 75%, S-ICD 83%). Comorbid hypertension and diabetes were more frequent among EV-ICD recipients. EV-ICD implantation required longer procedural (105 ± 30 vs 60 ± 20 min, p = 0.005) and fluoroscopy time (10.7 ± 2.1 vs 0.2 ± 0.1 min, p < 0.001). All implants achieved successful defibrillation testing. One non-device-related death occurred in the S-ICD group; all others survived at one-year follow-up. Appropriate shocks were delivered in two S-ICD patients; no inappropriate therapies occurred. Hospitalization for device-related complications occurred in one EV-ICD and two S-ICD patients. Conclusion EV-ICD demonstrates procedural feasibility and safety with reliable defibrillation and pacing capabilities while maintaining an extravascular approach. Compared with S-ICD, the system offers added functionality but requires fluoroscopy and longer procedural duration. Larger and longer-term studies are warranted to validate these early outcomes in Asian populations.Demographic1-year outcome
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Badaruddin et al. (2026) conducted a cohort in Risk of sudden cardiac death requiring implantable cardioverter-defibrillator (n=30). Extravascular ICD (EV-ICD) vs. Subcutaneous ICD (S-ICD) was evaluated on Procedural time (minutes) (p=0.005). Extravascular ICD implantation required significantly longer procedural time (105 vs 60 min, p=0.005) and fluoroscopy time (10.7 vs 0.2 min, p<0.001) compared to subcutaneous ICD.
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