SUBCUTANEOUS DEFIBRILLATOR

A subcutaneous defibrillator is a medical device designed to prevent sudden cardiac death. Unlike a transvenous (conventional) ICD, in which the leads are inserted into the heart through a vein and connected to the heart wall, the Subcutaneous ICD lead is placed under the skin rather than in the heart, leaving the heart and veins intact. The device is inserted under the skin in the armpit region and the electrode is also inserted under the skin in the sternal region of the chest, anteriorly. Unlike conventional transvenous ICD implants, subcutaneous defibrillators have significantly lower risk of complications and the operation for their implantation is also less invasive. A subcutaneous defibrillator is an automatic device that is able to autonomously recognize abnormalities in the heartbeat and when it detects a dangerously accelerated heart rhythm, it releases life-saving electrical discharges (shocks) to restore the heart to a normal rhythm.

PROS OF THE Subcutaneous ICD: It provides reliable protection against sudden death by leaving the heart and blood vessels intact. This avoids typical complications, such as systemic infections and the need to remove or extract the electrocatheters in the heart due to wear, tear or infections. Fewer physical limitations: Despite its size, the Subcutaneous ICD box is in fact larger than that of a transvenous ICD, the Subcutaneous ICD should not limit movements (of the arm) since it is not implanted under the collarbone.

CONS OF THE SUBCUTANEOUS ICD : No pacing: Patients with bradycardia (a slow heart rate), recurrent spontaneous ventricular tachycardia that is reliably treated with anti-bradycardia pacing (ATP) typically benefit more from a traditional transvenous ICD with pacing function. The SUB ICD does not provide cardiac resynchronization therapy (CRT).

In conclusion, the subcutaneous defibrillator is a valid therapeutic alternative only in some categories of patients at risk of sudden death.