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Subcutaneous and Transvenous ICDs: an Update on Contemporary Questions and Controversies

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

While the subcutaneous (S-) implantable cardioverter-defibrillator (ICDs) is an alternative to the transvenous (TV-) ICD in many patients, optimal use remains unclear. In this review, we summarize recent clinically relevant data on sensing algorithms, inappropriate shocks, defibrillation testing, and battery and electrode failures.

Recent Findings

Changes in sensing algorithms and S-ICD programming have significantly decreased inappropriate shock rates. Avoiding fat below the S-ICD coil and can is key for reducing the defibrillation threshold. While S-ICD battery and electrode failures have resulted in recalls, system components remain commercially available since failure rates are low and no other similar devices are available.

Summary

The S-ICD is a good alternative to the TV-ICD for many patients, and particularly in light of recently developed device algorithms and improvements in implant technique. Future research will need to better understand: the impact of S-ICD electrode and battery failures and the potential for integrating leadless pacing into a modular S-ICD platform.

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Authors and Affiliations

  1. Electrophysiology Section, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA

    Daniel J. Friedman

  2. The Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Albert S. Tully & Emily P. Zeitler

  3. Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Emily P. Zeitler

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  1. Daniel J. Friedman
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  2. Albert S. Tully
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  3. Emily P. Zeitler
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Correspondence to Daniel J. Friedman.

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Conflict of Interest

Dr. Friedman has received: research grants from the American Heart Association, National Cardiovascular Data Registry, Johnson & Johnson, Boston Scientific, Abbott, Medtronic, Merit Medical, and Biosense Webster; and consulting fees from Abbott, AtriCure, Sanofi, and NI Medical. Dr. Zeitler has received consulting fees from Medtronic, Inc., Biosense Webster, and Arena Pharmaceuticals (now Pfizer); support for travel to educational meetings from Medtronic Inc., Abbott, and Heart Rhythm Society; research grants from Boston Scientific and the National Cardiovascular Data Registry; and nonfinancial research support from Biosense Webster and Sanofi. Dr. Tully reports no conflicts.

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Some of the papers in this review were published by the authors. However, these were retrospective studies that received appropriate IRB approval and no informed consent was required.

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Friedman, D.J., Tully, A.S. & Zeitler, E.P. Subcutaneous and Transvenous ICDs: an Update on Contemporary Questions and Controversies. Curr Cardiol Rep 24, 947–958 (2022). https://doi.org/10.1007/s11886-022-01712-6

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