Introduction: Subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to transvenous implantable cardioverter-defibrillator (T-ICD) in select patients with complex anatomy, high infection risk and venous access issues. T-ICD is known to cause perioperative and long-term complications. Considering expanding indications for S-ICD, ongoing uncertainty in efficacy and unknown utility in low-risk patients, we performed this updated meta-analysis to study device related complications in both the systems. Methods: We performed a meta-analysis using electronic literature search to retrieve studies that compared S-ICD to T-ICD. Outcomes of interest were efficacy and device-related complications. Outcomes were pooled under random-effects and reported as risk ratios (RRs) and 95% CIs. 15 studies (observational, case-control and RCTs), median follow up 31.1 months, with variable heterogeneity for different outcomes (Fig-1), were included to capture real-world data. Results: A total of 21628 patients (S-ICD group n=3594, male 72.6%, mean age 50.1±10y and T-ICD group n=18034, male =72.6%, mean age 53.3±10.6y) were recruited. Lead-related complications were significantly lower in S-ICD, RR {0.21 [0.13, 0.34], P=<0.00001}. There were no significant difference in other device-related endpoints: 30-day complications RR{0.67 [0.38, 1.18], P=0.17}; surgical complications RR{0.70 [0.49, 1.01], P=<0.05}, inappropriate therapy RR{ 0.85 [0.67, 1.07], P=0.16}; appropriate therapy RR{ 0.62 [0.35, 1.09], P=0.10}, infections requiring surgery RR {0.84 [0.44, 1.59], P=0.59} and all-cause mortality RR{0.91 [0.68, 1.2, P=0.52]. Conclusion: Efficacy and safety of S-ICD is non-inferior to T-ICD and superior for lead-related complications.