Key result
Subcutaneous ICDs demonstrate high efficacy and safety and may be suitable for up to 70% of ICD-eligible patients who do not require pacing or cardiac resynchronization therapy.
Why the study?
Does subcutaneous ICD improve safety compared to transvenous ICD in patients with an indication for a defibrillator and no pacing requirements?
Does subcutaneous ICD improve safety compared to transvenous ICD in patients with an indication for a defibrillator and no pacing requirements?
The author argues for a stronger guideline recommendation for S-ICD in patients requiring a single-chamber ICD without pacing needs, representing up to 70% of ICD candidates.
Implantable cardioverter defibrillators (ICDs) have been shown to reduce the risk of sudden cardiac death in primary or secondary prevention with thousands of ICDs implanted every year worldwide. Whilst ICD are more commonly implanted transvenously (TV), this approach carries high risk of peri- and post-procedural complications. Subcutaneous ICD (S-ICD) have been introduced to overcome the intravascular complications of TV system by placing all metalware outside the chest cavity for those with an indication for a defibrillator and no pacing requirements. In conclusion, a review of the current guidelines recommendations regarding S-ICD may be needed considering the emerging evidence which shows high efficacy and safety with contemporary devices and programming algorithms. A stronger recommendation may be developed for selective patients who have an indication for single-chamber ICD in the absence of negative screening, recurrent monomorphic ventricular tachycardia, cardiac resynchronization therapy, or pacemaker indication. These criteria encapsulate a large proportion (around 70%!) of all ICD eligible patients.
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Abdin et al. (2022) conducted a review in Sudden cardiac death prevention. Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) vs. Transvenous Implantable Cardioverter Defibrillator (TV-ICD) was evaluated. Subcutaneous ICDs demonstrate high efficacy and safety and may be suitable for up to 70% of ICD-eligible patients who do not require pacing or cardiac resynchronization therapy.
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