The subcutaneous ICD: indications, implantation, follow-up, evidences
Vámos Máté1,2, Bári Zsolt2, Bógyi Péter2,, Duray Gábor Zoltán2,
1Frankfurti Egyetemi Klinika – Goethe Egyetem, Kardiológiai Osztály, Frankfurt am Main
2MH Egészségügyi Központ, Kardiológiai Osztály, Budapest
The subcutaneous ICD is implanted entirely extrathoracally and has been developed for the prevention of typical complications associated with transvenous ICD-electrodes. According to the guidelines of the European Society of Cardiology from 2015, S-ICD implantation may be considered as an alternative to the transvenous ICD system, when the venous access is difficult, after the removal of a transvenous ICD because of infections or in young patients, and should be considered in patients with an indication for an ICD when pacing for bradycardia, cardiac resynchronization or antitachycardia pacing are not needed. The S-ICD is implanted intermuscularly into a pocket between the fascias of the M. seratus anterior and the M. latissimus dorsi in sedato-analgesia combined with local anaesthesia. Follow-ups are performed with a special interrogation device with the possibility for programming two detection zones. However, the clinical experience and scientific evidences are still limited, based on the available data, the subcutaneous ICD is a safe and effective alternative for the prevention of sudden cardiac death. The combination with leadless pacemakers seems to be one of the most exciting future potentials of the S-ICD system.