Subcutaneous intracardiac defibrillator (s-icd): the better icd-alternative in athletes with arrhythmogenic risks?

Sudden Cardiac Arrest (SCA) is the leading cause of sudden death (SCD). In athletes under 35 years, SCA is believed to be mostly arrhythmogenic and often due to an underlying structural or electrical pathological heart condition, whereas coronary atherosclerosis is the most frequent aetiology of SCA among athletes above 35 years. Implantable Cardioverter Defibrillators (ICDs) with a transvenous lead are the therapy of choice for individuals at risk of SCD in both primary and secondary prevention. It bears the risk of lead-associated complications (fracture, dislocations, infection), which occur significantly more often in physically active patients like athletes. Considering these limitations,a completely subcutaneous ICD (S-ICD) system was designed to provide the life-saving benefit of the conventional TV-ICD, while avoiding the shortcomings of TV-lead ICD systems. Randomized comparison of S-ICD versus traditional TV-ICD sconfirmed S-ICD systems as a valid alternative in patients in whom bradycardia pacing or cardiac resynchronization therapy is not required. Because lead complications are associated with physical activity level (i.e. chest/shoulder/upper arm), S-ICD is the better ICD-therapy not only in young patients with an anticipated long-term need for defibrillation function but also in athletes.