Lower Complication Risk with Subcutaneous vs. Transvenous Implantable Defibrillator

Perioperative complications related to implantable cardioverter–defibrillator (ICD) placement occur in an estimated 3.4% of patients and can be life-threatening. A manufacturer-funded, randomized trial showed numerically fewer complications, including long-term ones, with subcutaneous ICDs (S-ICDs) compared with transvenous ICDs (TV-ICDs), but more inappropriate shocks (NEJM JW Cardiol Sep 2020 and N Engl J Med 2020; 383:526). The current trial, funded by the S-ICD manufacturer, was designed to evaluate perioperative complications of implantation.

Among 544 patients who received electrocardiographic screening for inappropriate sensing with the S-ICD, 503 (94%) passed the screen and were randomized to S-ICD or TV-ICD. During a mean follow-up …