Subcutaneous Implantable Cardioverter Defibrillator

Medically reviewed by Drugs.com. Last updated on Apr 6, 2025.

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What do I need to know about a subcutaneous implantable cardioverter defibrillator (S-ICD)?

An S-ICD is a small device to treat heart arrhythmias. Subcutaneous means the device is placed under your skin. This type of ICD does not use wires placed in the vein or heart. The device has a generator that is attached to a lead (wire). The ICD monitors your heart rhythm at all times. The generator sends electrical shocks if an abnormal rhythm is detected. Some arrhythmias may cause your heart to stop beating suddenly. The device can give a shock to make your heart start beating again.

How do I prepare for insertion of a S-ICD?

• Your healthcare provider will tell you how to prepare for the procedure. You may be told not to eat or drink anything after midnight on the day of your procedure. Arrange to have someone drive you home and stay with you after the procedure.
• Tell your provider about all medicines you currently take. Your provider will tell you if you need to stop any medicine for the procedure, and when to stop. Your provider will tell you which medicines to take or not take on the day of your procedure.
• Tell your provider about all your allergies, including antibiotics. You may be given an antibiotic through your IV to help prevent a bacterial infection.
• Make arrangements at home and work, if needed. You will not be able to lift anything heavy for several days after the procedure. Someone may need to help you around the house during this time. Ask your provider when you can return to work after the procedure. You may need to arrange for time off.

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What will happen during insertion of a S-ICD?

• You may be given general anesthesia to keep you asleep and free from pain during the procedure. You may instead be given moderate sedation, and local anesthesia to numb the area. You may still feel pressure or pushing during the procedure, but you should not feel pain.
• Your provider will make incisions at the bottom of your breastbone. A larger incision will be made a few inches below your left armpit. The generator will be placed under your skin through the incision under your armpit. The lead will be tunneled over your breastbone. An x-ray may be used to make sure the ICD is in the correct place.
• Your provider will test the ICD to make sure it will work when you need it. The incision will be closed with stitches. A bandage will be placed over your incision to protect the area and prevent an infection.

What should I expect after S-ICD insertion?

• You will be taken to a recovery room where you will rest until you are awake.
• You will be on a heart monitor. A heart monitor is an EKG that stays on continuously to record your heart's electrical activity.
• You may need a chest x-ray to make sure the ICD is in the right place.
• You may be able to leave when you are awake and your pain is controlled. You may go to a hospital room to spend the night.

What are the risks of a S-ICD?

You may bleed more than expected. You may develop an infection around your heart or in the incision areas. The device may cause the skin over it to erode (break down) over time. Your ICD may not shock your heart when it needs it. It may also shock when it should not.

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