How to minimize peri-procedural complications during subcutaneous defibrillator implant?

INTRODUCTION: Subcutaneous defibrillator (S-ICD) is the latest development in the clinically available devices for sudden cardiac death prevention. Experience from pivotal trials and post-marketing studies has proven the feasibility and safety of S-ICD. Extra-cardiac location of S-ICD obviates the need for transvenous leads which translates into lower incidence of lead-related complications and systemic infections. This is a review on peri-procedural interventions to minimize complications associated with S-ICD during implant and follow-up. AREAS COVERED: This paper will highlight the results of pertinent studies related to perioperative management of S-ICD and review the approaches to minimize the risk of complications such as hematoma at the pulse generator location, unsuccessful defibrillation due to suboptimal S-ICD lead and generator position, postoperative pain, inappropriate shocks due to T wave oversensing and interaction with concomitant cardiac implantable devices. An extensive literature search was performed to identify the relevant articles. EXPERT COMMENTARY: The use of S-ICD is expanding, and the published results suggest a preferential use of such devices for younger patients and those with a potential risk of infection from intravascular devices. The perioperative management of S-ICD has significantly evolved during a decade of experience. Contemporary experience suggests that these procedures are associated with minimal complications.