Skip to main content
SpringerLink
Log in

Prevention of Sudden Cardiac Death: Focus on the Subcutaneous Implantable Cardioverter-Defibrillator

  • Review article
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

The implantable cardioverter-defibrillator (ICD) is the most effective therapy to prevent sudden cardiac death (SCD) in high-risk patients. To overcome infections and failure of transvenous leads, the most frightening complications of conventional ICDs, a completely subcutaneous ICD (S-ICD) has been developed and is currently adopted in routine clinical practice. In view of their long life-expectancy, low competitive risk of dying from non-arrhythmic causes, and high lifetime risk of lead-related complications requiring surgical revisions, young patients with cardiomyopathies and inherited arrhythmia syndromes have traditionally been considered ideal candidates for the S-ICD. However, as growing evidence supported S-ICD safety and efficacy, initial niche implant indications were abandoned in favor of a widespread use of this technology, that is currently adopted in common ICD candidates with severe left ventricular dysfunction. Indeed, guidelines recommend S-ICD implantation as an alternative to TV-ICDs in all ICD candidates, unless pacing is required. This review focuses on the contemporary experience with the S-ICD and explores future scenarios in which device-to-device communication will enable to combine leadless therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Bloma N, Borggrefe M, Camm J, Elliott PM, et al. ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European. Eur Heart J. 2015;2015:2793–867.

    Article  Google Scholar 

  2. Moss AJ, Hall WJ, Cannom D, Daubert J, Higgins S, Klein H, Levine J. Improved survival with an implanted defibrillator in patients. N Engl J Med. 1996;335(26):1933–40.

    Article  CAS  PubMed  Google Scholar 

  3. Adduci C, Ali H, Francia P, Mantovani R, Palano F, Lupo P, Foresti S, et al. The subcutaneous implantable cardioverter-defibrillator: current trends in clinical practice between guidelines and technology progress. Eur J Intern Med. 2019.

  4. Van Rees JB, De Bie MK, Thijssen J, Borleffs CJW, Schalij MJ, Van Erven L. Implantation-related complications of implantable cardioverter-defibrillators and cardiac resynchronization therapy devices: a systematic review of randomized clinical trials. J Am Coll Cardiol. 2011;58:995–1000.

    Article  PubMed  Google Scholar 

  5. Kleemann T, Becker T, Doenges K, Vater M, Senges J, Schneider S, Saggau W, et al. Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation. 2007;115(19):2474–80.

    Article  PubMed  Google Scholar 

  6. Adduci C, Palano F, Francia P. Safety, efficacy and evidence base for use of the subcutaneous implantable cardioverter defibrillator. J Clin Med (internet). 2018;7(3):53. https://www.mdpi.com/2077-0383/7/3/53.

  7. Migliore F, Mattesi G, Zorzi A, Viani S, Bongiorni MG, Francia P, Curcio A, et al. The subcutaneous implantable cardioverter- defibrillator in clinical practice. Giornale Ital Cardiol. 2019. 641–550.

  8. Ali H, Lupo P, Cappato R. The entirely subcutaneous defibrillator—a new generation and future expectations. Arrhythmia Electrophysiol Rev (internet). 2015;04(2):116. https://www.radcliffecardiology.com/articles/entirely-subcutaneous-defibrillator-new-generation-and-future-expectations.

  9. Francia P, Ziacchi M, De Filippo P, Viani S, D’Onofrio A, Russo V, Adduci C, et al. Subcutaneous implantable cardioverter defibrillator eligibility according to a novel automated screening tool and agreement with the standard manual electrocardiographic morphology tool. J Interv Card Electrophysiol. 2018;52(1):61–7.

    Article  PubMed  Google Scholar 

  10. Knops RE, Olde Nordkamp LRA, De Groot JR, Wilde AAM. Two-incision technique for implantation of the subcutaneous implantable cardioverter-defibrillator. Hear Rhythm. 2013;10(8):1240–3.

    Article  Google Scholar 

  11. Migliore F, Allocca G, Calzolari V, Crosato M, Facchin D, Daleffe E, Zecchin M, et al. Intermuscular two-incision technique for subcutaneous implantable cardioverter defibrillator implantation: results from a multicenter registry. PACE Pacing Clin Electrophysiol. 2017;40:278–85.

    Article  PubMed  Google Scholar 

  12. Gold MR, Aasbo JD, El-Chami MF, Niebauer M, Herre J, Prutkin JM, Knight BP, et al. Subcutaneous implantable cardioverter-defibrillator post-approval study: clinical characteristics and perioperative results. Hear Rhythm. 2017;14(10):1456–63.

    Article  Google Scholar 

  13. Friedman DJ, Parzynski CS, Varosy PD, Prutkin JM, Patton KK, Mithani A, Russo AM, et al. Trends and in-hospital outcomes associated with adoption of the subcutaneous implantable cardioverter defibrillator in the United States. JAMA Cardiol. 2016;1(8):900–11.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Boersma L, Barr C, Knops R, Theuns D, Eckardt L, Neuzil P, Scholten M, et al. Implant and midterm outcomes of the subcutaneous implantable cardioverter-defibrillator registry: the EFFORTLESS study. J Am Coll Cardiol. 2017;70(7):830–41.

    Article  PubMed  Google Scholar 

  15. D’Onofrio A, Pieragnoli P, Biffi M, Nigro G, Migliore F, Francia P, De Filippo P, et al. Subcutaneous implantable cardioverter defibrillator implantation: an analysis of Italian clinical practice and its evolution. Int J Cardiol. 2018;162–7.

  16. Diemberger I, Migliore F, Ricciardi G, Ottaviano L, Tavoletta V, Francia P, Viani S, et al. Time to therapy delivery and effectiveness of the subcutaneous implantable cardioverter-defibrillator. Hear Rhythm. 2019;16(10):1531–7.

    Article  Google Scholar 

  17. Adduci C, Spadoni L, Palano F, Francia P. Ventricular fibrillation undersensing due to air entrapment in a patient implanted with a subcutaneous cardioverter defibrillator. J Cardiovasc Electrophysiol. 2019;30(8):1373–4.

    Article  PubMed  Google Scholar 

  18. Quast AFBE, Baalman SWE, Brouwer TF, Smeding L, Wilde AAM, Burke MC, Knops RE. A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: the PRAETORIAN score. Hear Rhythm. 2019;16:403–10.

    Article  Google Scholar 

  19. Quast AFBE, Baalman SWE, Betts TR, Boersma LVA, Bonnemeier H, Boveda S, Brouwer TF, et al. Rationale and design of the PRAETORIAN-DFT trial: a prospective randomized comparative trial of subcutaneous implantable cardioverter-defibrillator implantation with and without defibrillation testing. Am Heart J. 2019;214:167–74.

    Article  PubMed  Google Scholar 

  20. Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary. Circulation. 2018;138:e272–391.

    PubMed  Google Scholar 

  21. Weiss R, Knight BP, Gold MR, Leon AR, Herre JM, Hood M, Rashtian M, et al. Safety and efficacy of a totally subcutaneous implantable-cardioverter defibrillator. Circulation. 2013;128(9):944–53.

    Article  PubMed  Google Scholar 

  22. Lambiase PD, Barr C, Theuns DAMJ, Knops R, Neuzil P, Johansen JB, Hood M, et al. Worldwide experience with a totally subcutaneous implantable defibrillator: early results from the EFFORTLESS S-ICD registry. Eur Heart J. 2014;35(25):1657–65.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Quast AFBE, van Dijk VF, Yap SC, Maass AH, Boersma LVA, Theuns DA, Knops RE. Six-year follow-up of the initial Dutch subcutaneous implantable cardioverter-defibrillator cohort: long-term complications, replacements, and battery longevity. J Cardiovasc Electrophysiol. 2018;29(7):1010–6.

    Article  PubMed  Google Scholar 

  24. Francia P, Adduci C, Palano F, Semprini L, Serdoz A, Montesanti D, Santini D, et al. Eligibility for the subcutaneous implantable cardioverter-defibrillator in patients with hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol. 2015;26(8):893–9.

    Article  PubMed  Google Scholar 

  25. Srinivasan NT, Patel KH, Qamar K, Taylor A, Bacà M, Providência R, Tome-Esteban M, et al. Disease severity and exercise testing reduce subcutaneous implantable cardioverter-defibrillator left sternal ECG screening success in hypertrophic cardiomyopathy. Circ Arrhythmia Electrophysiol. 2017;10(4).

  26. De Bie MK, Thijssen J, Van Rees JB, Putter H, Van Der Velde ET, Schalij MJ, Van Erven L. Suitability for subcutaneous defibrillator implantation: results based on data from routine clinical practice. Heart. 2013;99(14):1018–23.

    Article  PubMed  Google Scholar 

  27. Melles MC, Yap SC, Bhagwandien RE, Sakhi R, Szili-Torok T, Theuns DAMJ. Frequency of need for antitachycardia or antibradycardia pacing or cardiac resynchronization therapy in patients with a single-chamber implantable cardioverter-defibrillator. Am J Cardiol. 2018;122(12):2068–74.

    Article  PubMed  Google Scholar 

  28. Boersma LV, El-Chami MF, Bongiorni MG, Burke MC, Knops RE, Aasbo JD, Lambiase PD, et al. Understanding outcomes with the EMBLEM S-ICD in primary prevention patients with low EF study (UNTOUCHED): clinical characteristics and perioperative results. Hear Rhythm. 2019;16(11):1636–44.

    Article  Google Scholar 

  29. Maron BJ, Casey SA, Olivotto I, Sherrid M V., Semsarian C, Autore C, Ahmed A, et al. Clinical course and quality of life in high-risk patients with hypertrophic cardiomyopathy and implantable cardioverter-defibrillators. Circ Arrhythmia Electrophysiol. 2018;11(4).

  30. Migliore F, Pelliccia F, Autore C, Bertaglia E, Cecchi F, Curcio A, Bontempi L, et al. Subcutaneous implantable cardioverter defibrillator in cardiomyopathies and channelopathies. J Cardiovasc Med. 2018. 633–42.

  31. Olde Nordkamp LRA, Postema PG, Knops RE, Van Dijk N, Limpens J, Wilde AAM, De Groot JR. Implantable cardioverter-defibrillator harm in young patients with inherited arrhythmia syndromes: a systematic review and meta-analysis of inappropriate shocks and complications. Hear Rhythm. 2016;13(2):443–54.

    Article  Google Scholar 

  32. Roberts BD, Hood RE, Saba MM, Dickfeld TM, Saliaris AP, Shorofsky SR. Defibrillation threshold testing in patients with hypertrophic cardiomyopathy. PACE Pacing Clin Electrophysiol. 2010;33(11):1342–6.

    Article  PubMed  Google Scholar 

  33. Francia P, Adduci C, Semprini L, Palano F, Santini D, Musumeci B, Santolamazza C, et al. Prognostic implications of defibrillation threshold testing in patients with hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol. 2017;28(1):103–8.

    Article  PubMed  Google Scholar 

  34. Weinstock J, Bader YH, Maron MS, Rowin EJ, Link MS. Subcutaneous implantable cardioverter defibrillator in patients with hypertrophic cardiomyopathy: an initial experience. J Am Heart Assoc. 2016;5(2):1–6.

    Article  Google Scholar 

  35. Friedman DJ, Parzynski CS, Heist EK, Russo AM, Akar JG, Freeman JV, Curtis JP, et al. Ventricular fibrillation conversion testing after implantation of a subcutaneous implantable cardioverter defibrillator report from the national cardiovascular data registry. Circulation. 2018;137:2463–77.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Maurizi N, Tanini I, Olivotto I, Amendola E, Limongelli G, Losi MA, Allocca G, et al. Effectiveness of subcutaneous implantable cardioverter-defibrillator testing in patients with hypertrophic cardiomyopathy. Int J Cardiol. 2017;231:115–9.

    Article  PubMed  Google Scholar 

  37. Lambiase PD, Gold MR, Hood M, Boersma L, Theuns DAMJ, Burke MC, Weiss R, et al. Evaluation of subcutaneous ICD early performance in hypertrophic cardiomyopathy from the pooled EFFORTLESS and IDE cohorts. Hear Rhythm. 2016;13(5):1066–74.

    Article  Google Scholar 

  38. Maurizi N, Olivotto I, Olde Nordkamp LRA, Baldini K, Fumagalli C, Brouwer TF, Knops RE, et al. Prevalence of subcutaneous implantable cardioverter-defibrillator candidacy based on template ECG screening in patients with hypertrophic cardiomyopathy. Hear Rhythm. 2016;13(2):457–63.

    Article  Google Scholar 

  39. Sakhi R, Yap SC, Michels M, Schinkel AFL, Kauling RM, Roos-Hesselink JW, Theuns DAMJ. Evaluation of a novel automatic screening tool for determining eligibility for a subcutaneous implantable cardioverter-defibrillator. Int J Cardiol. 2018;272(1):97–101.

    Article  PubMed  Google Scholar 

  40. Nazer B, Dale Z, Carrassa G, Reza N, Ustunkaya T, Papoutsidakis N, Gray A, et al. Appropriate and inappropriate shocks in hypertrophic cardiomyopathy patients with subcutaneous implantable cardioverter-defibrillators: an international multicenter study. Hear Rhythm. 2020;18.

  41. Migliore F, Viani S, Bongiorni MG, Zorzi A, Silvetti MS, Francia P, D’Onofrio A, et al. Subcutaneous implantable cardioverter defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy: results from an Italian multicenter registry. Int J Cardiol. 2019;1(280):74–9.

    Article  Google Scholar 

  42. Corrado D, Zorzi A, Cerrone M, Rigato I, Mongillo M, Bauce B, Delmar M. Relationship between arrhythmogenic right ventricular cardiomyopathy and brugada syndrome. Circ Arrhythmia Electrophysiol. 2016;9(4).

  43. Rudic B, Tülümen E, Berlin V, Röger S, Stach K, Liebe V, El-Battrawy I, et al. Low Prevalence of inappropriate shocks in patients with inherited arrhythmia syndromes with the subcutaneous implantable defibrillator single center experience and long-term follow-up. J Am Heart Assoc. 2017;6(10).

  44. Olde Nordkamp LRA, Conte G, Rosenmöller BRAM, Warnaars JLF, Tan HL, Caputo ML, Regoli F, et al. Brugada syndrome and the subcutaneous implantable cardioverter-defibrillator. J Am Coll Cardiol. 2016. 665–6.

  45. Conte G, Kawabata M, De Asmundis C, Taravelli E, Petracca F, Ruggiero D, Caputo ML, et al. High rate of subcutaneous implantable cardioverter-defibrillator sensing screening failure in patients with Brugada syndrome: a comparison with other inherited primary arrhythmia syndromes. Europace. 2018;20(7):1188–93.

    Article  PubMed  Google Scholar 

  46. Bögeholz N, Pauls P, Güner F, Bode N, Fischer A, Dechering D, Frommeyer G, et al. Direct comparison of the novel automated screening tool (AST) versus the manual screening tool (MST) in patients with already implanted subcutaneous ICD. Int J Cardiol. 2018;265:90–6.

    Article  PubMed  Google Scholar 

  47. Ferrero P, Ali H, Barman P, Foresti S, Lupo P, D’Elia E, Cappato R, et al. Entirely subcutaneous defibrillator and complex congenital heart disease: Data on long-term clinical follow-up. World J Cardiol (internet). 2017;9(6):547. https://www.wjgnet.com/1949-8462/full/v9/i6/547.htm.

  48. Tjong FVY, Brouwer TF, Kooiman KM, Smeding L, Koop B, Soltis B, Shuros A, et al. Communicating antitachycardia pacing-enabled leadless pacemaker and subcutaneous implantable defibrillator. J Am Coll Cardiol. 2016. 1865–6.

  49. Tjong FVY, Brouwer TF, Koop B, Soltis B, Shuros A, Schmidt B, Swackhamer B, et al. Acute and 3-month performance of a communicating leadless antitachycardia pacemaker and subcutaneous implantable defibrillator. JACC Clin Electrophysiol. 2017;3(13):1487–98.

    Article  PubMed  Google Scholar 

Download references

Funding

There are no funding sources relevant to this manuscript to declare.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035, 00189, Rome, Italy

    Carmen Adduci, Francesca Palano, Giacomo Silvetti, Pietro Cosentino & Pietro Francia

Authors
  1. Carmen Adduci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesca Palano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giacomo Silvetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pietro Cosentino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pietro Francia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pietro Francia.

Ethics declarations

Conflict of interest

P.F. received speaker fees and fellowship support from Boston Scientific, and research grants from Abbott.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adduci, C., Palano, F., Silvetti, G. et al. Prevention of Sudden Cardiac Death: Focus on the Subcutaneous Implantable Cardioverter-Defibrillator. High Blood Press Cardiovasc Prev 27, 291–297 (2020). https://doi.org/10.1007/s40292-020-00394-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40292-020-00394-x

Keywords

Search

Navigation