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The subcutaneous ICD for prevention of sudden cardiac death: Current evidence and future directions
Author(s) -
Steffel Jan
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14066
Subject(s) - medicine , sudden cardiac death , cardiac resynchronization therapy , observational study , bradycardia , intensive care medicine , implantable cardioverter defibrillator , icd 10 , randomized controlled trial , heart failure , ejection fraction , heart rate , blood pressure , psychiatry
Despite major advances in medical therapy, sudden cardiac death remains an important cause of cardiovascular mortality. In order to improve the risk‐benefit balance of transvenous implantable cardioverter‐defibrillator (ICD) systems, a totally subcutaneous ICD (S‐ICD) system was developed and approved for use in Europe in 2009. The currently available S‐ICD system has undergone several important hardware‐ and software‐related modifications and improvements over the last 10 years aimed at further improving its efficacy and safety. The results of the PRAETORIAN trial, that is, the first randomized comparison of S‐ICD versus transvenous ICDs, of the prospective UNTOUCHED study, and the overall consistent observational data underline that current generation S‐ICD systems may be a valid alternative in patients with an ICD indication in whom bradycardia pacing or cardiac resynchronization therapy is not required due to a lower risk of system‐related problems. This review summarizes the key differences between the two systems, improvements in hardware components and algorithms over time, as well as most recent clinical evidence regarding the efficacy and safety of the S‐ICD.