Choosing an implantable cardioverter-defibrillator system

ICD: implantable cardioverter-defibrillator; RV: right ventricle; S-ICD: subcutaneous ICD; TV-ICD: transvenous ICD.

* In patients who do not have a current need for pacing, it is difficult to accurately estimate the likelihood of developing a need for pacing. More details on the likelihood of pacing are available in UpToDate topics on specific diseases (eg, cardiac sarcoidosis) and in topics on choice of ICD system.

¶ The main advantages of S-ICD systems relative to TV-ICD systems are placement outside the vascular system and greater lead durability. The risk factors for ICD infection include indwelling vascular access devices (eg, central venous catheters) and ongoing dialysis. Lead fractures are more likely in younger patients and in patients who use their arms frequently (eg, physically active occupations, athletes). These issues are discussed in detail in UpToDate topics on the choice of ICD system.