Sudden cardiac death: New approaches for implantable cardioverter-defibrillators (ICDs)

The implantable cardioverter-defibrillator (ICD) has shown its superiority to anti-arrhythmic drugs in the prevention of sudden cardiac death. However, the conventional transvenous ICDs are still associated with substantial risks and comorbidities mainly related to the transvenous leads. The recent advent of an entirely sub-cutaneous ICD (S-ICD) represents an important progress in the defibrillation technology towards a less invasive approach. Clinical data are growing regarding the safety and efficacy of S-ICD in prevention of sudden cardiac death in selected patients without pacing indications. This novel technology seems promising and particularly beneficial in young patients with channelopathies, conditions at high risk of infection, or in those who experienced previous complications related to the transvenous leads. The S-ICD technology is still developing regarding the device, diagnostic capabilities, and the surgical implantation technique. Further advancements and potential integration with the leadless pacing technology may realize an outstanding evolution in defibrillation therapy and prevention of sudden cardiac death in the near future.