The subcutaneous implantable cardioverter-defibrillator should be reserved for niche indications

Since the introduction of the first implantable cardioverter-defibrillator (ICD) in 1980, ICDs have undergone significant improvements to become the pillar of sudden death prevention today. The first device consisted of a 250-g abdominal generator with a surgically applied pericardial patch.1 Over time, the generator decreased to one-fifth of its original size, and the pericardial patch was replaced by transvenous leads with integrated defibrillation coils. However, for patients with impaired venous access or children with congenital heart disease, epicardial systems remained their only option until the development of the subcutaneous implantable cardioverter-defibrillator (S-ICD).