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Subcutaneous ICD Advantages — EECC MCQ

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ModerateCardiac DevicesSubcutaneous ICD AdvantagesEECC

A 35-year-old man with Brugada syndrome and recurrent VF episodes receives an ICD. His cardiologist discusses the subcutaneous ICD (S-ICD) as an alternative to transvenous ICD. What is the main advantage of S-ICD?

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Correct answer: E — S-ICD avoids intravascular leads entirely — the lead and generator are subcutaneous, eliminating risks of lead-related endocarditis, vascular injury, and tricuspid valve damage; it is ideal for young patients with long life expectancy

The S-ICD places the lead subcutaneously along the sternum and the generator laterally, with no components inside the heart or vascular system. Advantages: (1) no endovascular leads (eliminating lead-related endocarditis, lead fracture, venous occlusion, and tricuspid valve damage); (2) no intravascular access needed; (3) particularly suitable for young patients with long life expectancy (decades of transvenous leads increases cumulative complication risk). Limitations: (1) cannot deliver anti-tachycardia pacing (ATP — effective for terminating most monomorphic VTs without shock); (2) cannot provide bradycardia pacing (except brief post-shock pacing); (3) cannot deliver CRT; (4) larger generator; (5) inappropriate shocks from T-wave oversensing. The ESC 2022 VA/SCD Guidelines recommend S-ICD when ATP and bradycardia pacing are not needed (Class IIa).

Reference: ESC (2022): VA/SCD Guidelines