Subcutaneous implantable cardioverter defibrillator (ICD)

Cardiovascular disease is a major public health issue accounting for almost 17 million deaths per year globally. According to estimates, 40-50% of them are sudden cardiac deaths. Approximately 6 million sudden cardiac deaths are caused by ventricular tachyarrhythmias. Several underlying acquired or congenital cardiac conditions are associated with an increased risk of ven-tricular arrhythmias. The implantable cardioverter-defibrillator (ICD) device detects and termi-nates these life-threatening ventricular tachyarrhythmias. Based on evidence from several trials, clinical practice guidelines of cardiological societies rec-ommend the ICD in patients at high risk of developing ventricular tachyar-rhythmia (primary prevention), or in patients who have experienced a prior episode of life-threatening ventricular tachyarrhythmias (secondary preven-tion). Recently, the subcutaneous implantable ICD emerged as a promising alter-native to the established transvenous ICD to overcome short- and long-term complications associated with the implantation of transvenous leads and di-rect contact with the heart. Specifically, such complications are pneumo-thorax, cardiac perforation, lead fracture, lead-dysfunction, infections (e.g. lead endocarditis) and venous thrombosis. The subcutaneous ICD leaves the heart and vascular system untouched. It is important to note, however, that the subcutaneous ICD is restricted to patient populations who are not de-pendent on pacing therapy for bradycardia, anti-tachycardia (ATP), or resyn-chronization (CRT). Based on NICE (National Institute for Health and Care Excellence) guidance document, the current evidence on the efficacy and safety of subcutaneous ICD for preventing sudden cardiac death is adequate to support the use of this procedure.

Tags: defibrillator, implantable
Year: 2018