Subcutaneous Implantable Cardioverter Defibrillator (S-ICD)

Overview

A Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) is a specialized type of Implantable Cardioverter Defibrillator (ICD) designed to prevent sudden cardiac death. Unlike traditional ICDs, which use one to three wires (leads) running through veins to the heart, the S-ICD is implanted just beneath the skin.

ICDs, including S-ICDs, are recommended for individuals with certain heart conditions to monitor and manage their heart rhythms. When the device detects a dangerously rapid or irregular heartbeat, it delivers an electric shock to the chest to restore a normal rhythm, a process known as defibrillation.

The S-ICD offers several advantages over traditional transvenous ICDs, including:

• Reduced risk of perforation or tears in the heart tissue.
• Lower likelihood of infections, such as endocarditis.
• Minimization of lead-related issues, such as breakage that requires replacement or removal.
• Decreased risk of blood clots or thrombosis.

Reasons for undergoing the procedure

ICDs are frequently utilized in patients with heart problems like:

• Ventricular fibrillation.
• Ventricular tachycardia.
• A history of sudden cardiac arrest.

For those who: An S-ICD might be the best ICD option.

• Are susceptible to infections or have a history of ICD infections.
• Possess a challenging-to-access cardiac anatomy.
• Have highly active lifestyles
• Are younger, with a life expectancy that exceeds the usual lifespan of transvenous ICDs.

Risks

Complications with S-ICD implantation are possible, however they are uncommon. Among them are:

• Bleeding.
• Blood clots.
• An infection around the cut.
• Injury to adjacent tissues (nerves, muscles, tendons, etc.).

Over time, additional dangers could be:

• Skin erosion in the vicinity of the device.
• The device moving away from the initial implant location.
• Irritation caused by the leads.
• Unwarranted shocks from the device.

Before the procedure

Prior to the S-ICD operation, you will get precise instructions from your doctor. They might request that you:

• A few days prior to the procedure, stop taking certain drugs, such as blood thinners.
• The day before the surgery, refrain from eating or drinking.
• Make plans for a lift home following the procedure.

Prior to the surgery, a doctor might:

• Label anatomical sites for incisions and device implantation.
• Cleanse and shave the region where the gadget will be inserted by your surgeon.
• Place an IV line in your arm to receive fluids and medication.
• Use antibiotics to prevent infections.
• Use anesthetic to prevent pain.
• To keep your arms in place and keep you from contacting the sterile area, use a soft strap.

During the procedure

The procedure to implant an S-ICD typically takes a few hours and involves placing two components: a generator and a defibrillation lead.

Most patients receive conscious sedation, meaning they are awake but in a relaxed state during the procedure. You should not experience any pain; if you do, inform your doctor immediately.

Throughout the procedure, your doctor will closely monitor your vital signs and the progress of the implantation, often utilizing:

• A blood pressure measuring arm cuff.
• To monitor the electrical impulses passing through your heart, get an electrocardiogram (EKG).
• Fluoroscopy uses X-rays to assist your doctor in visualizing the leads during the procedure.
• An oxygen meter to measure blood oxygen concentrations.

The surgeon will make two or three small incisions on the left side of your chest or under your left arm. The generator is placed under your skin, near your rib cage, within the fatty tissue. The lead is then carefully tunneled under the skin towards the center of your chest, near the breastbone, and directed upwards toward your neck.

Before completing the procedure, the surgeon will test the system by inducing an abnormal heart rhythm to ensure the device delivers a shock correctly. During this testing phase, you will be kept sedated with medication to prevent any discomfort. Once the testing is successfully completed, the incisions will be closed with stitches.

After the procedure

After the procedure, you will be taken to a recovery room where the doctor will monitor you as the anesthesia wears off. Your doctor may order an X-ray to verify the placement of the device components.

Most patients can go home the same day, but you will need someone to drive you home due to the effects of the anesthesia.

Outcome

Your doctor will provide detailed instructions on living with an S-ICD, which may include the following:

• Attend routine follow-up appointments to monitor the device’s functionality and your heart health.
• Wear a bracelet or carry a card identifying you as having an ICD, which can be crucial for emergency medical personnel.
• Inform all other medical professionals about your S-ICD.
• Consult your doctor before traveling, particularly if you will be passing through metal detectors or other security devices.

An S-ICD battery lasts nearly five years on average. Battery life can vary based on factors such as device settings and frequency of activation. Your healthcare provider will monitor the battery life during follow-up appointments.

If you notice any signs of infection or heart trouble after your S-ICD implantation, it’s important to seek medical attention promptly. Symptoms to watch for include chest pain, dizziness, drainage of fluid or pus from the incision site, unresolved cardiac symptoms that were present before the implantation, redness, swelling, or pain around the incision area, and shortness of breath.