Abstract
The use of subcutaneous implantable cardioverter-defibrillators (S-ICDs) has increased over time. Device-based algorithms have been developed to reduce inappropriate shocks. New implant techniques have been developed including the two-incision technique and the placement of the generator submuscularly. More patients are being implanted without general anesthesia. This review summarizes the newest S-ICD features, surgical implantation methods, and device-related safety and efficacy findings.
Highlights
Traditional implantable cardioverter-defibrillators (ICDs) consist of a pulse generator placed in the pectoral area and endocardial leads with high-voltage shocking coils
The subcutaneous ICD (S-ICD) was designed to provide effective defibrillation while avoiding the complications related to the presence of hardware in the intravascular
This review summarizes the newest S-ICD features, surgical implantation methods, and device-related safety and efficacy findings
Summary
Traditional implantable cardioverter-defibrillators (ICDs) consist of a pulse generator placed in the pectoral area and endocardial leads with high-voltage shocking coils. Software changes included the SMR8 algorithm, which, in a computer model, decreased T-wave oversensing (TWOS) by 40% with no change in the sensitivity of ventricular arrhythmia events.[2] in 2016, the current third-generation EMBLEMTM MRI S-ICD (Boston Scientific, Natick, MA, USA) was released. A new feature of the current EMBLEMTM S-ICD device (Boston Scientific, Natick, MA, USA) is the SMART Pass arrhythmia discrimination algorithm, which is designed to reduce inappropriate shocks due to TWOS.[3] It includes an additional high-pass filter to reduce the amplitude of lower-frequency signals such as T-waves while maintaining sensing of higher-frequency R-waves. Care must be taken to prevent damage to the long thoracic nerve with these approaches
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