Subcutaneous implantable cardioverter-defibrillators: history and current state

The review indicates the priority of implantable cardioverter-defibrillators in the prevention of sudden cardiac death. Attention is drawn to the fact that most defibrillators implanted in the world are endocardial systems. The presence of the leads in the heart chambers is associated with a number of specific complications that cannot be prevented. It reduces the function capabilities of the defibrillator and increases the risk of morbidity and mortality. Subcutaneous systems eliminate the need for implantation of the endocardial leads, being preferable for patients with a long life expectancy. The main disadvantages include the impossibility to terminate ventricular tachycardia painlessly because of lack of antitachycardiac pacing and the inability to perform cardiac pacing for bradycardia. To assess the safety and efficacy of subcutaneous defibrillators, large multicenter studies have been conducted and are still ongoing. Their findings have demonstrated that subcutaneous systems are not inferior to traditional endocardial ones according to selected criteria. Recent advances in subcutaneous defibrillators have resulted in their superiority in some functional parameters of these systems over endocardial ones. Devices have a priority for patients with a high risk of infection and vascular access difficulties. Nevertheless, due to known limitations of subcutaneous systems, there are more stringent requirements for the selection of candidates for surgery. Among the entire cohort of patients requiring implantation of any type of defibrillator, there are many candidates for a subcutaneous device, as that can be conditionally equated to a single-chamber endocardial defibrillator, which is implanted in the majority of cases. The likelihood of the need to change in the future the device to a more functional endocardial is defined as low.

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