Subcutaneous ICD — EECC MCQ

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ModerateArrhythmia & ElectrophysiologySubcutaneous ICDEECC

A 55-year-old man with ischaemic cardiomyopathy (LVEF 30%) and prior sustained VT is being considered for an ICD. He has a BMI of 45 kg/m² and has had recurrent device pocket infections with previous cardiac devices. Which ICD system should be considered?

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Correct answer: C — Subcutaneous ICD (S-ICD)

The subcutaneous ICD (S-ICD) avoids transvenous leads and intravascular hardware, making it the preferred option for patients at high risk of device-related infections (including those with prior pocket infections) and those with difficult venous access. The S-ICD cannot deliver anti-tachycardia pacing (ATP) or permanent pacing, so it is unsuitable for patients requiring these. However, for this patient with a secondary prevention indication and no pacing requirement (no CRT indication specified, no bradycardia), the S-ICD provides appropriate defibrillation while minimising infection risk. The 2022 ESC VA/SCD Guidelines recommend S-ICD as an alternative to transvenous ICD when pacing therapy is not needed (Class IIa).

Reference: ESC (2022): Guidelines on Ventricular Arrhythmias and Prevention of Sudden Cardiac Death