Subcutaneous implantable cardioverter defibrillator insertion for preventing sudden cardiac death

2.1 Sudden cardiac death is often caused by ventricular arrhythmias (ventricular tachycardia or ventricular fibrillation). The most common cause of ventricular arrhythmias is underlying heart disease.

2.2 Prevention of sudden cardiac death can be primary, which is defined as preventing a first life-threatening arrhythmic event in someone who is at high risk of such an event. Or, it can be secondary, which refers to preventing further life-threatening events in survivors of previous serious ventricular arrhythmias. Treatment with an implantable cardioverter defibrillator (ICD) is recommended in NICE's technology appraisal guidance on implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure for patients with arrhythmias and those at risk of sudden cardiac death.

2.3 An ICD consists of a generator, which contains a battery, capacitor and sophisticated electronic circuitry, and 1 or more leads. The device senses and detects arrhythmias, and delivers pacing impulses or defibrillating shocks to the heart as necessary, to restore normal cardiac rhythm. A conventional transvenous ICD consists of a generator under the skin below the clavicle and 1 or more leads passed through a vein into the heart.