Implantable cardioverter-defibrillator (ICD) is an implantable device inside the body that helps with cardioversion, defibrillation, and pacing of the heart. The use of subcutaneous ICD is on the rise as transvenous ICD has resulted in complications. This study aims to compare the safety and efficacy of subcutaneous and transvenous ICD. 

This noninferiority trial included a total of 849 patients with an indication for an ICD. The patients were assigned to receive a subcutaneous ICD (n=426 ) or transvenous ICD (n=423). The primary outcomes of the study were a composite of device-related complications and inappropriate shocks. The incidence of deaths and appropriate shocks were also considered.

During a median follow-up of 49.1 months, a primary end-point event occurred in 68 patients in each group (hazard ratio 0.99). Device-related complications were reported in 31 patients in the subcutaneous ICD group, as compared with 44 in the transvenous ICD group. The incidence of inappropriate shocks was 41 and 29 in the two groups, respectively. The death occurred in 83 patients in the subcutaneous ICD group, as compared with 68 in the transvenous ICD group, with appropriate shocks occurring in 83 and 57 patients in the two groups, respectively.

The research concluded that in patients with an indication for an ICD, subcutaneous ICD was non-inferior to ICD.

Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa1915932