title: The subcutaneous implantable cardioverter-defibrillator.
abstract: OBJECTIVE
  To consider the case of need that underpinned the development of the subcutaneous implantable cardioverter-defibrillator (SICD), the preclinical and clinical data obtained so far, its current role and likely future.
  
  
  RESULTS
  The data from prospective clinical evaluation of the device demonstrated safety and efficacy leading to Food and Drug Administration approval. This superseded earlier reports from Europe that raised some clinical concerns, previously anticipated through the introduction of new technology. Recent estimates indicate maybe 55% of patients in routine clinical practice needing an ICD are potentially suitable for a subcutaneous device.
  
  
  CONCLUSIONS
  The SICD provides a useful alternative for high-energy (ICD) therapy in those deemed at risk and who need defibrillation and in whom there are no indications for cardiac resynchronization, bradycardia support or antitachycardia pacing. There is the possibility of both higher specificity and the avoidance of myo-cellular damage with shock delivery, and if these two aspects play out subcutaneous defibrillation could become an option of choice in many settings.
authors.affiliation: Papworth Hospital, Cambridge, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Grace
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods; D058409:Cardiac Resynchronization Therapy Devices; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D018795:Device Approval; D004554:Electric Countershock / Q000379:methods; D006801:Humans; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration