A Different Kind of Defibrillator

New device is wired under the skin

Good news for people who are “wired” with defibrillators that jumpstart their hearts when they skip a beat (or more): A new device approved by the U.S. Food and Drug Administration is stronger and kinder to the body. That’s because the wires (called leads) that run from the device to the heart are implanted under the skin rather than threaded through veins.

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Due to the strength of these leads, subcutaneous (under the skin) implantable cardioverter defibrillators (ICDs) function well and can be replaced more easily when needed.

What’s new about subcutaneous ICDs

“Implant technology has changed a lot over the years, and so has the data supporting it,” says Bruce Wilkoff, MD, Director of Pacemakers and ICDs at Cleveland Clinic. The old leads can break and wear out. And they are not always easy to remove and replace.

For these reasons, subcutaneous ICDs could be a real game-changer for some people with arrhythmias. Plus, the way the device identifies the dangerously fast heart rhythms could reduce the number of shocks a patient receives, waiting until the device is certain that the irregular heartbeat is serious and requires action.

Subcutaneous ICDs “seem to eliminate a lot of the mechanisms for inappropriate detection,” Dr. Wilkoff says. This makes living with the device a lot more comfortable since a shock feels like a swift kick in the chest.

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Implantable Cardioverter Defibrillator 

Who benefits from the new ICDs

Dr. Wilkoff estimates that half of patients with defibrillators are potential candidates for this new subcutaneous ICD. This device cannot also act as a pacemaker—and about half of patients who have defibrillators need pacing to keep their hearts up to speed. It is however most useful in patients who have trouble with the veins used with more traditional ICDs.

Is this device better than the standard defibrillator? Not necessarily. More data is needed to accurately compare the two. But it gives patients additional options, and that’s always a good thing.

“We don’t really know which approach is best, but we do know that there is a group of patients who are not suitable for venous leads, and those patients clearly will benefit from these developments in implant technology,” Dr. Wilkoff says. 

More Information

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Dos and Don’ts: Life with an ICD

ICDs That Shock Less Are Better


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