A subcutaneous implantable cardioverter defibrillator (S-ICD) is a medical device. It can help prevent sudden cardiac death in people with abnormally fast heart rhythms. An S-ICD is implanted under your skin rather than through your veins. It’s less invasive than a transvenous ICD and may involve fewer complications.
A subcutaneous implantable cardioverter defibrillator (S-ICD) is a type of implantable cardioverter defibrillator (ICD). An ICD is an electronic medical device that helps prevent sudden cardiac death. The subcutaneous version of the device goes under your skin.
Healthcare providers recommend ICDs for people with certain cardiac conditions to monitor heart rhythm. When the device detects a very fast, abnormal heart rhythm, it delivers a shock to your chest to reset your heart rhythm. This is defibrillation.
Traditional ICDs use one to three wires (leads) that run through veins to your heart. This is a transvenous approach (TV-ICD). But subcutaneous ICDs are less invasive because they use only one lead that runs under your skin, not through your veins. This can reduce the risk of complications and make it easier to replace or remove leads.
ICDs are often used in people who have heart conditions such as:
An S-ICD may be the best ICD option in people who:
Some ICDs also act as pacemakers, which help regulate and maintain normal heart rate and rhythm.As of 2022, S-ICDs do not have the ability to pace. Therefore, they can't help your heart maintain a normal rate or rhythm. They can only monitor your heart and shock it out of an abnormal heart rhythm if needed.
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Your healthcare provider will give you specific instructions before the S-ICD procedure. They may ask you to:
Just before the procedure, a healthcare provider may:
The procedure to implant an S-ICD usually takes a couple of hours. It requires inserting two parts: a generator and a defibrillation lead.
Most people receive conscious sedation and are awake but relaxed during the procedure. You should not feel any pain, so tell your healthcare provider if you do.
During the procedure, your healthcare provider continuously monitors your vital signs and the progress of the procedure, often using:
A surgeon will make two or three incisions on the left side of your chest or under your left arm. They insert the generator next to your rib cage, under your skin and inside fat. Then they tunnel the lead under your skin to the middle of your chest near your breastbone, then up toward your neck.
Before finishing the procedure, they test the system by inducing an abnormal heart rhythm and allowing the device to shock you to prove that it’s working properly. (Your medical team will keep you under sedation with medications to ensure you don’t feel any pain.) Then they use stitches to close the incisions.
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After the procedure, you go to a recovery room. There, the healthcare team monitors you as the anesthesia wears off. Your healthcare provider may order an X-ray to check the position of the device components.
Most people go home the day of the procedure. Because of the anesthesia, you'll need someone to drive you home.
An S-ICD can prevent sudden cardiac death and lower the risks associated with transvenous ICD, such as:
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Implantation of an S-ICD involves the risk of complications, although rare. They include:
Other risks over time may include:
Your healthcare provider will give you specific instructions about living with an S-ICD. They may include:
You can’t recharge an S-ICD’s battery because it’s sealed within the device. When the battery depletes, a surgeon will have to remove and replace the device.
On average, an S-ICD battery lasts almost five years. Battery life depends on several factors, including its settings and how often the device activates. Your healthcare provider will check battery life at follow-up appointments.
If you experience signs of infection or heart trouble after S-ICD implantation, seek medical attention. Signs may include:
A note from Cleveland Clinic
A subcutaneous implantable cardioverter defibrillator (S-ICD) is a medical device implanted under your skin. It can help prevent sudden cardiac death in people with certain heart conditions who meet other criteria. If you need an implanted defibrillator, ask your healthcare provider if an S-ICD is right for you.
Last reviewed on 08/05/2022.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy