Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is the latest option among devices clinically available for the prevention of sudden cardiac death, with experience from previous trials and postmarketing studies supporting the feasibility and safety of this kind of system. The extracardiac positioning of the S-ICD obviates the need for transvenous leads, which translates into lower incidence rates of lead-related complications and systemic infections. This review will highlight the results of pertinent studies related to the perioperative management of S-ICDs and review potential approaches to minimizing the risk of complications such as hematoma at the pulse generator location, unsuccessful defibrillation due to suboptimal S-ICD lead and generator positioning, and postoperative pain. An extensive literature search using PubMed was conducted to identify relevant articles.
Highlights
The use of monitored anesthesia care (MAC) is anticipated to decrease complications associated with endotracheal intubation and prevent significant hemodynamic compromise associated with general anesthesia
There is a small risk of inappropriate therapy due to electromagnetic interference from the left ventricular assist devices (LVADs) that can be circumvented by changing the sensing vector of the subcutaneous implantable cardioverter-defibrillator (S-ICD) after LVAD placement
S-ICD has emerged as a viable alternative to transvenous defibrillators for the prevention of sudden cardiac death (SCD) in patients without a pacing indication or a known history of monomorphic ventricular tachycardia amenable to antitachycardia pacing
Summary
SRIKANTH VEDACHALAM, do,[1] SCHUYLER COOK, do,[2] TANNER KOPPERT, ms,[1] TOSHIMASA OKABE, md,[1] RAUL WEISS, md, fhrs,[1] and MUHAMMAD R.
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