Implantation of a Subcutaneous Implantable Cardioverter Defibrillator: Report From the National Cardiovascular Data Registry. Circulation 2018; 137:2463. 12. Anvari A, Stix G, Grabenw ger M, et al. Comparison of three cardioverter defibrillator implantation techniques: initial results with transvenous pectoral implantation. Pacing Clin Electrophysiol 1996; 19:1061. 13. Miller MA, Palaniswamy C, Dukkipati SR, et al. Subcutaneous Implantable Cardioverter- Defibrillator Implantation Without Defibrillation Testing. J Am Coll Cardiol 2017; 69:3118. https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 12/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate 14. de Bie MK, Thijssen J, van Rees JB, et al. Suitability for subcutaneous defibrillator implantation: results based on data from routine clinical practice. Heart 2013; 99:1018. 15. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91. 16. Huang J, Patton KK, Prutkin JM. Concomitant Use of the Subcutaneous Implantable Cardioverter Defibrillator and a Permanent Pacemaker. Pacing Clin Electrophysiol 2016; 39:1240. 17. Aziz S, Leon AR, El-Chami MF. The subcutaneous defibrillator: a review of the literature. J Am Coll Cardiol 2014; 63:1473. 18. Majithia A, Estes NA 3rd, Weinstock J. Advances in sudden death prevention: the emerging role of a fully subcutaneous defibrillator. Am J Med 2014; 127:188. 19. Pettit SJ, McLean A, Colquhoun I, et al. Clinical experience of subcutaneous and transvenous implantable cardioverter defibrillators in children and teenagers. Pacing Clin Electrophysiol 2013; 36:1532. 20. Bettin M, Larbig R, Rath B, et al. Long-Term Experience With the Subcutaneous Implantable Cardioverter-Defibrillator in Teenagers and Young Adults. JACC Clin Electrophysiol 2017; 3:1499. 21. Kuschyk J, Stach K, T l men E, et al. Subcutaneous implantable cardioverter-defibrillator: First single-center experience with other cardiac implantable electronic devices. Heart Rhythm 2015; 12:2230. 22. Groh CA, Sharma S, Pelchovitz DJ, et al. Use of an electrocardiographic screening tool to determine candidacy for a subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2014; 11:1361. 23. Randles DA, Hawkins NM, Shaw M, et al. How many patients fulfil the surface electrocardiogram criteria for subcutaneous implantable cardioverter-defibrillator implantation? Europace 2014; 16:1015. 24. Jarman JW, Lascelles K, Wong T, et al. Clinical experience of entirely subcutaneous implantable cardioverter-defibrillators in children and adults: cause for caution. Eur Heart J 2012; 33:1351. 25. Olde Nordkamp LR, Dabiri Abkenari L, Boersma LV, et al. The entirely subcutaneous implantable cardioverter-defibrillator: initial clinical experience in a large Dutch cohort. J Am Coll Cardiol 2012; 60:1933. https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 13/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate 26. K be J, Reinke F, Meyer C, et al. Implantation and follow-up of totally subcutaneous versus conventional implantable cardioverter-defibrillators: a multicenter case-control study. Heart Rhythm 2013; 10:29. 27. Lambiase PD, Barr C, Theuns DA, et al. Worldwide experience with a totally subcutaneous implantable defibrillator: early results from the EFFORTLESS S-ICD Registry. Eur Heart J 2014; 35:1657. 28. Moore JP, Mond sert B, Lloyd MS, et al. Clinical Experience With the Subcutaneous Implantable Cardioverter-Defibrillator in Adults With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2016; 9. 29. Le n Salas B, Trujillo-Mart n MM, Garc a Garc a J, et al. Subcutaneous implantable cardioverter-defibrillator in primary and secondary prevention of sudden cardiac death: A meta-analysis. Pacing Clin Electrophysiol 2019; 42:1253. 30. Weiss R, Knight BP, Gold MR, et al. Safety and efficacy of a totally subcutaneous implantable- cardioverter defibrillator. Circulation 2013; 128:944. 31. Jarman JW, Todd DM. United Kingdom national experience of entirely subcutaneous implantable cardioverter-defibrillator technology: important lessons to learn. Europace 2013; 15:1158. 32. Aydin A, Hartel F, Schl ter M, et al. Shock efficacy of subcutaneous implantable cardioverter- defibrillator for prevention of sudden cardiac death: initial multicenter experience. Circ Arrhythm Electrophysiol 2012; 5:913. 33. Dabiri Abkenari L, Theuns DA, Valk SD, et al. Clinical experience with a novel subcutaneous implantable defibrillator system in a single center. Clin Res Cardiol 2011; 100:737. 34. Burke MC, Gold MR, Knight BP, et al. Safety and Efficacy of the Totally Subcutaneous Implantable Defibrillator: 2-Year Results From a Pooled Analysis of the IDE Study and EFFORTLESS Registry. J Am Coll Cardiol 2015; 65:1605. 35. Chue CD, Kwok CS, Wong CW, et al. Efficacy and safety of the subcutaneous implantable cardioverter defibrillator: a systematic review. Heart 2017; 103:1315. 36. Boersma L, Barr C, Knops R, et al. Implant and Midterm Outcomes of the Subcutaneous Implantable Cardioverter-Defibrillator Registry: The EFFORTLESS Study. J Am Coll Cardiol 2017; 70:830. 37. Gold MR, Aasbo JD, El-Chami MF, et al. Subcutaneous implantable cardioverter-defibrillator Post-Approval Study: Clinical characteristics and perioperative results. Heart Rhythm 2017; 14:1456. https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 14/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate 38. Quast ABE, Baalman SWE, Brouwer TF, et al. A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter- defibrillator: The PRAETORIAN score. Heart Rhythm 2019; 16:403. 39. Amin AK, Gold MR, Burke MC, et al. Factors Associated With High-Voltage Impedance and Subcutaneous Implantable Defibrillator Ventricular Fibrillation Conversion Success. Circ Arrhythm Electrophysiol 2019; 12:e006665. 40. Winter J, Siekiera M, Shin DI, et al. Intermuscular technique for implantation of the subcutaneous implantable cardioverter defibrillator: long-term performance and complications. Europace 2017; 19:2036. 41. Poole JE. Novel ICD therapy begets novel ICD detection: first look at the performance of the subcutaneous ICD discrimination algorithm. Heart Rhythm 2014; 11:1359. 42. Basu-Ray I, Liu J, Jia X, et al. Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Meta-Analysis of Case-Control Studies. JACC Clin Electrophysiol 2017; 3:1475. 43. Brouwer TF, Driessen AHG, Olde Nordkamp LRA, et al. Surgical Management of Implantation-Related Complications of the Subcutaneous Implantable Cardioverter- Defibrillator. JACC Clin Electrophysiol 2016; 2:89. 44. Kooiman KM, Knops RE, Olde Nordkamp L, et al. Inappropriate subcutaneous implantable cardioverter-defibrillator shocks due to T-wave oversensing can be prevented: implications for management. Heart Rhythm 2014; 11:426. 45. Daubert JP, Zareba W, Cannom DS, et al. Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol 2008; 51:1357. 46. Sharma D, Sharma PS, Miller MA, et al. Position and sensing vector-related triple counting and inappropriate shocks in the subcutaneous implantable cardioverter-defibrillator system. Heart Rhythm 2015; 12:2458. 47. Gold MR, Weiss R, Theuns DA, et al. Use of a discrimination algorithm to reduce inappropriate shocks with a subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2014; 11:1352. 48. Sheldon SH, Cunnane R, Lavu M, et al. Perioperative hematoma with subcutaneous ICD implantation: Impact of anticoagulation and antiplatelet therapies. Pacing Clin Electrophysiol 2018; 41:799. 49. Theuns DA, Crozier IG, Barr CS, et al. Longevity of the Subcutaneous Implantable Defibrillator: Long-Term Follow-Up of the European Regulatory Trial Cohort. Circ Arrhythm Electrophysiol 2015; 8:1159. https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 15/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate 50. Knops RE, Olde Nordkamp LRA, Delnoy PHM, et al. Subcutaneous or Transvenous Defibrillator Therapy. N Engl J Med 2020; 383:526. 51. Brouwer TF, Yilmaz D, Lindeboom R, et al. Long-Term Clinical Outcomes of Subcutaneous Versus Transvenous Implantable Defibrillator Therapy. J Am Coll Cardiol 2016; 68:2047. 52. Gold MR, Theuns DA, Knight BP, et al. Head-to-head comparison of arrhythmia discrimination performance of subcutaneous and transvenous ICD arrhythmia detection algorithms: the START study. J Cardiovasc Electrophysiol 2012; 23:359. Topic 97158 Version 32.0 https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 16/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate GRAPHICS Subcutaneous implantable cardioverter-defibrillator (S- ICD) pulse generator and electrode Photograph showing the pulse generator (center) and electrode for a subcutaneous implantable cardioverter-defibrillator (S-ICD). Image provided courtesy of Boston Scienti c. Copyright 2014 Boston Scienti c Corporation or its a liates. All rights reserved. Graphic 97569 Version 1.0 https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 17/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate Posteroanterior (PA) and lateral chest radiographs of a subcutaneous implantable cardioverter-defibrillator (S-ICD) Posteroanterior (PA) and lateral chest radiographs of a subcutaneous implantable cardioverter-defibrillator (S-ICD) with the defibrillation lead visible adjacent to the sternum and the pulse generator in the axilla. Graphic 97372 Version 2.0 https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 18/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate Subcutaneous ICD pulse generator Example of subcutaneous implantable cardioverter-defibrillator pulse generator commonly used in practice in 2015. ICD: implantable cardioverter-defibrillator. Graphic 104722 Version 3.0 https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 19/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate S-ICD intramuscular insertion Subcutaneous implantable cardioverter defibrillator (S-ICD) implantation with the device placed in the intermuscular plane. Panel A shows the intermuscular space (*) between the latissimus dorsi muscle (arrow) and the serratus anterior muscle (double arrow) after dissection, but prior to placement of the subcutaneous ICD generator. Panel B shows the postoperative, lateral chest x-ray after subcutaneous ICD implantation with the device positioned posteriorly (dashed arrow). Graphic 129617 Version 1.0 https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 20/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate Lateral view of a patient with a subcutaneous implantable cardioverter-defibrillator (S-ICD) Lateral view of a patient with an S-ICD. S-ICD: subcutaneous implantable cardioverter-defibrillator. Reproduced with permission from: Magnusson P, Pergolizzi JV, LeQuang JA. The Subcutaneous Implantable Cardioverter-De brillator. In: Cardiac Pacing and Monitoring, Min M (Ed), IntechOpen, 2019. Copyright Peter Magnusson, MD, PhD. Graphic 131058 Version 2.0 https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 21/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate Subcutaneous implantable cardioverter-defibrillator Modi ed from: 1. Al-Khatib SM, Friedman P, Ellenbogen KA. De brillators: Selecting the Right Device for the Right Patient. Circulation 2016; 134:1390. 2. Mayo Clinic. Subcutaneous implantable cardioverter-de brillator (S-ICD). https://www.mayoclinic.org/diseases-conditions/ventricular-tachycardia/multimedia/img- 20303862 (Accessed on March 31, 2021). Graphic 130973 Version 1.0 https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 22/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate Comparison of transvenous and subcutaneous ICD pulse generators Comparison of four transvenous ICD pulse generators and one subcutaneous ICD pulse generator commonly used in practice in 2015. The term "subcutaneous" here refers to the ICD electrode positioning, which is subcutaneous rather than transvenous. Note the significantly larger size of the subcutaneous ICD pulse generator. ICD: implantable cardioverter-defibrillator. Graphic 104723 Version 2.0 https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 23/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate Algorithm for choosing subcutaneous ICD ICD: implantable cardioverter-defibrillator; CRT: cardiac resynchronization therapy; TV: transvenous; ATP: antitachycardia pacing; S-ICD: subcutaneous ICD. Graphic 97368 Version 4.0 https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 24/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate Summary of major clinical studies investigating the efficacy and safety of the subcutaneous implantable cardioverter-defibrillator (S-ICD) Successful M Number conversion Complications Appropriate Inappropriate fo Author of with requiring detection shock rate (year) patients defibrillator intervention rate (%) (%) dur (n) function (%) (mo testing (%) Lambiase 472 NR 7% 99.7% 6.4% et al [1] (2014) Weiss et al 314 99.8% 14% 100% 1.3% [2] (2013) K be et al 69 NR 4% 95.5% 4% [3] (2013) Jarman et 111 100% 15% 100% 16% al (2013) [4] Jarman et al (2012) [5] 16 100% 25% 100% 19% Aydin et al 40 NR 5% 97.5% 13% [6] (2012) Olde Nordkamp et al (2012) 118 NR 13% 100% 14% [7] Dabiri et al (2011) [8] 31 100% 16% 100% 10% Bardy et al (2010) 55 100% 9% 98% 11% [9] References: 1. Lambiase PD, Barr C, Theuns DAMJ, et al. Worldwide experience with a totally subcutaneous implantable de brillator: early results from the EFFORTLESS S-ICD Registry. Eur Heart J 2014; 35:1657. 2. Weiss R, Knight BP, Gold MR, et al. Safety and e cacy of a totally subcutaneous implantable-cardioverter de brillator. Circulation 2013; 128:944. 3. K be J, Reinke F, Meyer C, et al. Implantation and follow-up of totally subcutaneous versus conventional implantable cardioverter-de brillators: a multicenter case-control study. Heart Rhythm 2013; 10:29. https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 25/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate 4. Jarman JWE, Todd DM. United Kingdom national experience of entirely subcutaneous implantable cardioverter- de brillator technology: important lessons to learn. Europace 2013; 15:1158. 5. Jarman JWE, Lascelles K, Wong T, et al. Clinical experience of entirely subcutaneous implantable cardioverter- de brillators in children and adults: cause for caution. Eur Heart J 2012; 33:1351. 6. Aydin A, Hartel F, Schl ter M, et al. Shock e cacy of subcutaneous implantable cardioverter-de brillator for prevention of sudden cardiac death: initial multicenter experience. Circ Arrhythm Electrophysiol 2012; 5:913. 7. Olde Nordkamp LRA, Dabiri Abkenari L, Boersma LVA, et al. The entirely subcutaneous implantable cardioverter- de brillator: initial clinical experience in a large Dutch cohort. J Am Coll Cardiol 2012; 60:1933. 8. Dabiri Abkenari L, Theuns DAMJ, Valk SDA, et al. Clinical experience with a novel subcutaneous implantable de brillator system in a single center. Clin Res Cardiol 2011; 100:737. 9. Bardy GH, Smith WM, Hood MA, Crozier IG, Melton IC, Jordaens L, et al. An entirely subcutaneous implantable cardioverter-de brillator. N Engl J Med 2010; 363:36. Graphic 97342 Version 1.0 https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 26/27 7/6/23, 11:02 AM Subcutaneous implantable cardioverter defibrillators - UpToDate Contributor Disclosures Bradley P Knight, MD, FACC Grant/Research/Clinical Trial Support: Abbott [Electrophysiology]; Atricure [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Electrophysiology]; BSCI [Electrophysiology]; MDT [Electrophysiology]; Philips [Electrophysiology]. Consultant/Advisory Boards: Abbott [Electrophysiology]; Atricure [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Electrophysiology]; BSCI [Electrophysiology]; CVRx [Heart failure]; MDT [Electrophysiology]; Philips [Electrophysiology]; Sanofi [Arrhythmias]. Speaker's Bureau: Abbott [Electrophysiology]; Biosense Webster [Electrophysiology]; Biotronik [Electrophysiology]; Boston Scientific [Transeptal catheterization]; BSCI [Electrophysiology]; MDT [Electrophysiology]. All of the relevant financial relationships listed have been mitigated. Samuel L vy, MD No relevant financial relationship(s) with ineligible companies to disclose. Nisha Parikh, MD, MPH No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/subcutaneous-implantable-cardioverter-defibrillators/print 27/27