No, not in the conventional sense. This is the most clinically important difference between an S-ICD and a standard transvenous ICD.
An S-ICD can deliver brief post-shock pacing — a short burst of pacing in the seconds immediately after it has delivered a defibrillation shock, to prevent the heart pausing dangerously in that window. But it cannot provide ongoing bradycardia pacing (pacing that keeps the heart from beating too slowly on a continuous basis) or anti-tachycardia pacing (ATP, which is rapid pacing used to interrupt a fast heart rhythm before it needs a shock).
This means an S-ICD is not appropriate if:
- You have a slow heart rate that requires a pacemaker to maintain an adequate rate
- You have a type of fast heart rhythm that can be reliably terminated with ATP, which is less painful than a full shock
Some patients who need both ICD protection and pacing have an S-ICD combined with a separate leadless pacemaker (such as the Micra device), which sits inside the right ventricle and handles pacing without transvenous leads. This combination is used in selected cases where both subcutaneous defibrillation and pacing are needed but traditional transvenous leads are undesirable. Your electrophysiologist will determine which configuration is right for you.