Subcutaneous Defibrillator (SICD)

What is a subcutaneous defibrillator?

A defibrillator is a small metal can that is placed in the body, usually down the left side and is connected to a wire that is placed under the skin on top of the breast bone. The subcutanoeus defibrillator is able to monitor the heart for rapid heart rhythms that may be life threatening and deliver an electric shock to try to reset the heart beat (defibrillation).

Who needs a defibrillator ?

Defibrillators are offered to patients who have a higher than average risk of developing life threatening rhythm problems. This can be after a heart attack, where the heart muscle is weakened or where a inherited condition makes life threatening rhythm problems more likely. There are many other reasons why a doctor may recommend a defibrillator.

Why a  subcutaneous defibrillator implant?

Subcutaneous defibrillators may be preferred for some patients who need a defibrillator as they do not require leads to be placed in the veins directly into the heart, instead the lead is placed under the skin.

How do I know if I am suitable for subcutaneous defibrillator implant?

You will require a screening assessment which is conducted  by Boston Scientific the company that manufacturers the subcutaneous defibrillator. If you do not meet the screening criteria, you will usually be assessed for a standard defibrillator.

What happens during a subcutaneous defibrillator implant?

The procedure is usually done under general anaesthetic , and this will be discussed with you.

A cut is made in the skin on the left hand side of the chest, under the armpit. A pocket is made in the deep tissues for the defibrillator to be placed.

A tunnel is then made to the bottom of the breastbone and then the lead is passed along the tunnel and then up, underneath the skin, on top of the breastbone.

The small cuts are then closed with absorbable stitches and often skin glue.

Once the device is in place, the heart will be stimulated into one of the rapid rhythms and the device checked to ensure it can deliver the defibrillation to reset the heart beat.

If you are feeling well, you will often be allowed home the same day.

What are the risks ?

Defibrillator implantation, like any medical procedure, carries with it risks, thankfully these are uncommon. The risks for any individual person depend on many factors and will be discussed in detail. The main risks include: Infection of the defibrillator system, there may be some discomfort, there may be bleeding or bruising around the site and rarely the defibrillator may not work and a conventional defibrillator may have to be placed instead. Thankfully, the majority of patients undergoing defibrillator implantation do so without any complication.

The defibrillator is a sophisticated computer, but it may deliver a shock to the heart even when a shock is not required, this is called an inappropriate shock and may be uncomfortable, this is thankfully rare with modern defibrillators.

It is very important that you understand all the risks and the benefits of having the procedure, and this will be discussed with you in detail and any appointment.

Where are the procedures done  ?

The subcutaneous defibrillator implant procedures can be performed in Spire Shaw Fair Park hospital in Edinburgh, and BMI Ross Hall Hospital in Glasgow. The consultations to discuss management and outpatient care before and after the procedure can be offered in any of the clinics in Dundee, Edinburgh or Glasgow.