Key result
The extravascular ICD demonstrated effective defibrillation and anti-tachycardia pacing in approximately 77% of episodes, offering a complementary non-transvenous alternative to the subcutaneous ICD.
Why the study?
To examine two non-transvenous ICD platforms, the S-ICD and EV-ICD, and provide a framework for patient selection, preimplant screening, and implantation.
May guide non-transvenous ICD selection by pacing needs; leaves open head-to-head outcome trials.
PURPOSE OF REVIEW: This review examines the two non-transvenous implantable cardioverter-defibrillator (ICD) platforms; the subcutaneous ICD (S-ICD) and the extravascular ICD (EV-ICD), providing a framework for patient selection, preimplant screening, and implantation. RECENT FINDINGS: Long-term trial and registry data confirm that the S-ICD provides reliable defibrillation without intravascular leads, with lower rates of lead failure, infection, and pneumothorax compared to transvenous systems. The EV-ICD, utilizing a substernal lead, has demonstrated effective defibrillation and anti-tachycardia pacing in approximately 77% of episodes, while offering pause-prevention pacing in a smaller pulse generator with greater projected longevity. Device selection should be individualized based on pacing requirements, prior sternotomy status, and anticipated arrhythmia substrate. The S-ICD remains the only option after sternotomy, while the EV-ICD extends the non-transvenous paradigm by integrating anti-tachycardia and pause-prevention pacing. Together, these devices offer complementary solutions for patients who do not require chronic pacing or resynchronization therapy.
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Sugrue et al. (2026) conducted a review in Arrhythmia / ICD indication. Subcutaneous ICD (S-ICD) and Extravascular ICD (EV-ICD) vs. Transvenous ICD systems was evaluated. The extravascular ICD demonstrated effective defibrillation and anti-tachycardia pacing in approximately 77% of episodes, offering a complementary non-transvenous alternative to the subcutaneous ICD.
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