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The subcutaneous implantable cardioverter-defibrillator: Current trends in clinical practice between guidelines and technology progress

Published:April 17, 2019DOI:https://doi.org/10.1016/j.ejim.2019.04.003

      Highlights

      • Early S-ICD experience included younger and less “sick” patients.
      • S-ICD is a valuable therapy in clinical practice with rapid expansion worldwide.
      • Current S-ICD recipients are more similar to the “standard” ICD candidates.
      • Current guidelines approve the S-ICD to prevent SCD unless pacing is required.
      • Some patients (e.g., young, high infection risk) may benefit more from the S-ICD.

      Abstract

      The subcutaneous implantable cardioverter defibrillator (S-ICD) is a valuable alternative to the conventional trans-venous ICD (TV-ICD) for the prevention of sudden cardiac death (SCD). Prospective registries showed that the S-ICD is safe and effective in treating ventricular tachyarrhythmias in high-risk patients without pacing indications. While in earlier studies patients implanted with S-ICDs were young and mostly affected by channelopathies, contemporary S-ICD cohorts include patients with severely impaired left ventricular function and significant comorbidities. This review focuses on S-ICD evidence-based use and highlights current gaps between guidelines recommendations and real-world clinical practice.

      Keywords

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