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Efficacy and safety of the subcutaneous implantable cardioverter defibrillator: a systematic review
  1. Colin Dominic Chue1,
  2. Chun Shing Kwok1,2,
  3. Chun Wai Wong2,
  4. Ashish Patwala1,
  5. Diane Barker1,
  6. Amir Zaidi3,
  7. Mamas A Mamas1,2,
  8. Colin Cunnington3,
  9. Fozia Z Ahmed3
  1. 1 Heart and Lung Centre, Royal Stoke University Hospital, Stoke-on-Trent, UK
  2. 2 Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
  3. 3 Manchester Heart Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
  1. Correspondence to Dr Fozia Z Ahmed, Department of Cardiology, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK; foziaahmed{at}


Background Subcutaneous implantable cardioverter defibrillators (S-ICDs) are considered an alternative to conventional transvenous ICDs (TV-ICDs) in patients not requiring pacing.

Methods We searched MEDLINE and EMBASE for studies evaluating efficacy and safety outcomes in S-ICD patients. Outcomes were pooled across studies.

Results Sixteen studies were included with 5380 participants (mean age range 33–56 years). Short-term follow-up data were available for 1670 subjects. The most common complication was pocket infection, affecting 2.7%. Other complications included delayed wound healing (0.6%) and wound discomfort (0.8%). 3.8% of S-ICDs were explanted, most commonly for pocket infection. Mortality rates in hospital (0.4%) and during follow-up (3.4% from 12 studies reporting) were low. Incidence of ventricular arrhythmia varied from 0% to 12%. Overall shock efficacy exceeded 96%. Inappropriate shocks affected 4.3% and was most commonly caused by T-wave oversensing.

Conclusions Although long-term randomised data are lacking, observational data suggest similar shock efficacy and short-term complication rates between the S-ICD and TV-ICD.

  • implanted cardiac defibrillators
  • ventricular fibrillation
  • ventricular tachycardia
  • systematic review

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  • Contributors FZA conceived and planned the study. CSK performed the search for relevant studies. Data were screened by CSK and CDC and extracted by CDC, CWW, CC and FZA. Data analysis was performed by CSK and CDC. CDC wrote the first draft of the paper. All authors contributed to the interpretation of the findings and critically revised it for intellectual content.

  • Patient consent This is a systematic review.

  • Provenance and peer review Not commissioned; externally peer reviewed.