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Subcutaneous Implantable Defibrillator

An S-ICD is a device that detects and treats abnormal rhythms in the heart ventricle. In a life-threatening situation, the device works by sending either small electrical impulses or an electrical shock to your heart to restore normal heart rhythm.

Your doctor has recommended you undergo the installation of an subcutaneous implantable cardioverter defibrillator (S-ICD).
You might not have heard this medical term before now and may be feeling unsure about the nature of the procedure.
This information sheet outlines what the procedure is and what preparations and risks are involved.

After you read this information sheet, you might still have questions. If you do, please contact the team at Heart HQ. We’re here to help.

What’s a Subcutaneous ICD?

A subcutaneous implantable defibrillator is a
small battery-powered device with one
electrode wire that runs along the breastbone
and down towards the left side of the chest
under the skin. It provides protection for a
broad range of patients at risk for sudden
cardiac death while also providing protection
from the risks and complications associated
with transvenous leads.

In a life-threatening situation, the device
works by sending an electrical shock to your
heart to restore normal heart rhythm.

How does it work?

The procedure for installing your S-ICD is not as
complex as you might think.

The procedure starts with an intravenous line
(IV) being placed into a vein in your arm. This is
for the medical team to administer medication
during or after your procedure. You will receive
an antibiotic to prevent an infection of your
new S-ICD. A sedative will also be given. The
implant can be performed under general
anaesthetic, local anaesthetic or alternatively a
regional nerve block.

Your Doctor will make 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.

During the procedure, your doctor will be able to see the lead using x-ray imaging. Once your doctor has positioned the lead correctly, the lead and the S-ICD will be tested to make sure they are working properly.

Then your skin will be closed using dissolving sutures.

What happens after the procedure?

You will not be able to drive a vehicle for two weeks after having an ICD installed. You will also need to limit your arm movement on the side of your defibrillator as much as possible during those first two weeks to allow the ICD wires to settle.

About two weeks after your procedure you will have a clinic appointment where a pacing technician will check your defibrillator and your doctor will remove the wound dressing.

You will then have follow up appointments on a regular basis at the clinic or though our remote home monitoring service. We will check the operation of your ICD and review any abnormal heart rhythms stored on the device.

What kind of risks are associated with this procedure?

Any kind of procedure carries some element of risk, often very small and rare.

Your doctor has balanced the benefits and risks of carrying out the test against the benefits and risks of not proceeding. If your doctor has recommended this procedure, they believe there is benefit to you going ahead.

It’s important you understand the risks involved so you can make an informed decision.

Here are the most commonly reported risks and complications associated with an S-ICD installation.

Common risks and complications (>5% of cases)

• Bruising and bleeding in the S-ICD

Uncommon risks and complications (1–5% of cases)

  • The ICD’s leads can move—the leads will need to be put back in place by repeating this procedure
  • Pocket infection

Rare risks and complications (less than 1% of cases)

  • Punctured lung or pneumothorax
  • Lead Fracture
  • Battery Issue
  • Blood clot in the lung or pulmonary embolism (PE)
  • Heart attack
  • Stroke
  • Death from any complications

Subcutaneous implantable
cardioverter defibrillator info sheet