title: The Italian subcutaneous implantable cardioverter-defibrillator survey: S-ICD, why not?
abstract: OBJECTIVE
  A recommendation for a subcutaneous-implantable cardioverter-defibrillator (S-ICD) has been added to recent European Society of Cardiology Guidelines. However, the S-ICD is not ideally suitable for patients who need pacing. The aim of this survey was to analyse the current practice of ICD implantation and to evaluate the actual suitability of S-ICD.
  
  
  RESULTS
  The survey 'S-ICD Why Not?' was an independent initiative taken by the Italian Heart Rhythm Society (AIAC). Clinical characteristics, selection criteria, and factors guiding the choice of ICD type were collected in consecutive patients who underwent ICD implantation in 33 Italian centres from September to December 2015. A cardiac resynchronization therapy (CRT) device was implanted in 39% (369 of 947) of patients undergoing de novo ICD implantation. An S-ICD was implanted in 12% of patients with no CRT indication (62 of 510 with available data). S-ICD patients were younger than patients who received transvenous ICD, more often had channelopathies, and more frequently received their device for secondary prevention of sudden death. More frequently, the clinical reason for preferring a transvenous ICD over an S-ICD was the need for pacing (45%) or for antitachycardia pacing (36%). Nonetheless, only 7% of patients fulfilled conditions for recommending permanent pacing, and 4% of patients had a history of monomorphic ventricular tachycardia that might have been treatable with antitachycardia pacing.
  
  
  CONCLUSIONS
  The vast majority of patients needing ICD therapy are suitable candidates for S-ICD implantation. Nevertheless, it currently seems to be preferentially adopted for secondary prevention of sudden death in young patients with channelopathies.
authors.affiliation: Unit of Electrophysiology, S. Anna Hospital ASST Lariana, Via Ravona 1, San Fermo della Battaglia, 22020 Como, Italy.
authors.forename: Giovanni Luca
authors.initials: GL
authors.lastname: Botto
authors.affiliation: Cardiology, University of Tor Vergata, 00133 Rome, Italy.
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Forleo
authors.affiliation: Cardiology and Arrhythmology Clinic, Università Politecnica delle Marche, 60020 Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.affiliation: Cardiology, Casa di Cura Montevergine, Mercogliano, 83013 Avellino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Solimene
authors.affiliation: EP lab, A.S. Ospedaliera S. Croce e Carle, 12100 Cuneo, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Vado
authors.affiliation: Electrophysiology, Ospedale San Martino, 161332 Genova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bertero
authors.affiliation: Cardiology Unit, 'Card. G. Panico' Hospital, Tricase, 73039 Lecce, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Palmisano
authors.affiliation: Cardiology, Ospedale Vito Fazzi, 73100 Lecce, Italy.
authors.forename: Ennio
authors.initials: E
authors.lastname: Pisanò
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rapacciuolo
authors.affiliation: Department of Cardiovascular Surgery Sant'Anna Hospital, 88100 Catanzaro, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Infusino
authors.affiliation: Department of Cardiology, Fondazione Policlinico S. Matteo IRCCS, 27100 Pavia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vicentini
authors.affiliation: Cardiology, Ospedale S. Anna e S. Sebastiano, 81100 Caserta, Italy.
authors.forename: Miguel
authors.initials: M
authors.lastname: Viscusi
authors.affiliation: Cardiology, Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Ferrari
authors.affiliation: Cardiology, Ospedale SS. Annunziata, 87100 Cosenza, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Talarico
authors.affiliation: Unit of Electrophysiology, S. Anna Hospital ASST Lariana, Via Ravona 1, San Fermo della Battaglia, 22020 Como, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Russo
authors.affiliation: Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Cardiology, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.affiliation: CRM dept, Boston Scientific, 20134 Milan, Italy.
authors.forename: Mariolina
authors.initials: M
authors.lastname: Lovecchio
authors.affiliation: CRM dept, Boston Scientific, 20134 Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
authors.affiliation: Cardiology, Ospedale Monaldi, 80131 Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Onofrio
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000235:genetics / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects; D058409:Cardiac Resynchronization Therapy Devices; D053447:Channelopathies; D000066491:Clinical Decision-Making; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D004562:Electrocardiography; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012307:Risk Factors; D055502:Secondary Prevention / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Implantable cardioverter-defibrillator; Indication; Pacing; Subcutaneous; Sudden death; Survey; Ventricular arrhythmias