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Subcutaneous ICD (S-ICD)

A subcutaneous implantable cardioverter-defibrillator (S-ICD) is a type of defibrillator that is implanted just under the skin of the chest, rather than being placed inside the veins and heart like a traditional ICD. The S-ICD system includes a pulse generator that is implanted just under the left armpit and a subcutaneous electrode that runs parallel to the sternum.
Like traditional ICDs, the S-ICD is used to treat life-threatening arrhythmias, which are abnormal heart rhythms that can lead to sudden cardiac arrest. The S-ICD is designed to monitor the heart’s electrical activity and deliver a shock to restore a normal rhythm if necessary. However, unlike traditional ICDs, the S-ICD does not require a lead to be placed inside the heart, which can reduce the risk of complications associated with lead placement, such as infection and lead fracture.
Fig 94 SQICD
Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have some advantages and disadvantages when compared to traditional implantable cardioverter-defibrillators (ICDs).
Advantages of S-ICDs include:
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Lower risk of lead-related complications

Since the S-ICD does not require leads to be placed inside the heart, the risk of lead-related complications such as lead fracture, lead dislodgement, and infection is reduced.



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Easier to implant

S-ICDs are generally easier and quicker to implant than traditional ICDs since they do not require the placement of leads inside the heart.

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Less invasive

S-ICDs are less invasive than traditional ICDs since they are implanted just under the skin of the chest.

Disadvantages of S-ICDs include:
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Limited pacing capabilities

S-ICDs do not have the ability to provide pacing therapy, which may be necessary for some patients.

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Limited programming options

S-ICDs have fewer programming options than traditional ICDs, which may limit the ability to fine-tune the device for optimal performance.

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Higher cost

S-ICDs are generally more expensive than traditional ICDs.

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Limited battery life

S-ICDs have a limited battery life compared to traditional ICDs, which may more frequent battery replacement.

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Larger size

The S-ICD has a larger size battery compared to a traditional ICD since it has to deliver the shock from a distance further away from the heart

The S-ICD is typically recommended for patients who do not require pacing therapy or ATP, as it does not have pacing capabilities. However, it may be an option for younger patients to preserve vein patency or patients who have an increased risk of lead-related complications or who have a limited number of veins available for lead placement. The decision to use an S-ICD should be made on a case-by-case basis by an electrophysiologist in consultation with the patient.

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