An S-ICD is considered when someone needs ICD protection against life-threatening arrhythmias but does not currently require ongoing pacing therapy. It tends to be particularly well suited to:
- Younger patients, where avoiding transvenous leads reduces lifetime exposure to the complications those leads can cause over decades of use, including fracture, infection, and the need for lead extraction procedures
- People with congenital heart disease or unusual cardiac anatomy, where placing transvenous leads is technically difficult or carries higher risk
- Patients at elevated risk of device infection, where keeping leads out of the bloodstream reduces the chance of serious endovascular infection
- People who have already experienced transvenous lead complications, such as lead fracture or infection, and need a different approach
Before an S-ICD can be implanted, a sensing screening test is carried out to confirm that the device will be able to reliably detect the heart’s rhythm from the subcutaneous position. A small number of patients do not pass this screening and require a transvenous device instead. Your electrophysiologist will assess which type of device is most appropriate for your individual situation.