The Totally Subcutaneous ICD System: Hype or Hope? February 11, 2010

The “weakest link” of the implantable cardioverter defibrillator (ICD) system has been demonstrated to be the endocardial lead system. These leads require specialized training and skill to implant.

What if there was no need for an endovascular lead? Perhaps systems might last longer and more physicians would be able to perform the procedure, potentially allowing more patients to receive these life-saving devices.

On the other hand, a “totally subcutaneous” ICD lead system still includes a “lead,” which is implanted underneath the skin. In fact, it is unclear whether this lead system, which is closer to the skin, would withstand trauma and if it would truly “last longer” than current transvenous systems.

In addition, “painless” therapy using anti-tachycardia pacing will not be available with the initial protoypes. Although there may be some future cost advantages and the availability of the totally subcutaneous systems might allow more physicians to implant the device, controversy still exists regarding potential benefits versus disadvantages of this system.

Tell me what you think in the comments section or hear more about this debate and others at the Heart Rhythm Society annual meeting to be held in May 2010 in Denver: view the “Debates” section of the Online Itinerary Planner.