A small machine that can save lives from sudden cardiac arrest: Everything about the S-ICD in simple terms

We have all heard of Sudden Cardiac Arrest, right? Even for someone who thinks they are healthy, their heart can suddenly stop working and become life-threatening. This is something that really scares many people. But with the advancement of medical science, there are amazing devices today that can prevent such sudden deaths. Today, we are going to talk about such a life-saving, small device. This is called the S-ICD.

Simply put, what is this S-ICD?

The full meaning of S-ICD is Subcutaneous Implantable Cardioverter Defibrillator . Although the name is a bit complicated, the operation is very simple. This is a small electronic device that is surgically implanted under your skin. It's about the size of a small matchbox.

The main function of this device is to continuously monitor your heart rhythm. If your heart rhythm becomes dangerously fast, that is, if you develop an abnormal rhythm (arrhythmia) that is life-threatening, this S-ICD device immediately recognizes it. After recognizing it, it delivers a small electrical shock to your chest. This shock restores the irregular heartbeat to normal, that is, a normal rhythm. We call this process defibrillation .

What is the difference between a regular ICD and an S-ICD?

You may have heard of regular ICD devices. The S-ICD is also a type of ICD. But there is a big, important difference between the two.

In traditional ICD devices (called Transvenous ICDs or TV-ICDs), one or more wires (called leads) connected to the device are passed through your blood vessels (veins) and inserted into your heart. This is a somewhat complicated process.

But that doesn't happen with the S-ICD. The special thing about this is that the wires are not sent into the heart or into the blood vessels . The S-ICD device and the wires connected to it are completely placed under your skin. This makes it very safe. The risks of infections and blood clots that can occur when wires are sent through the blood vessels are very low with the S-ICD. Also, if you ever need to replace this device, it is very easy.

Who needs this S-ICD?

ICD devices are usually recommended for people with certain heart rhythm conditions. For example:

• Ventricular Tachycardia: A condition in which the lower chambers of the heart (ventricles) beat too fast.
• Ventricular Fibrillation: A very dangerous condition in which the lower chambers of the heart quiver uncontrollably. This can lead to instant death.
• People who have previously suffered a sudden cardiac arrest: To prevent the risk of such a situation occurring again.

But among these people, an S-ICD is especially suitable for the following people:

• People at high risk of infection: For example, those who have had previous ICD infections or those who are immunocompromised.
• People with difficult access to blood vessels: Some people may have difficulty passing wires through blood vessels, depending on their body position.
• People with very active lifestyles: People like athletes. Because the wires of the S-ICD are not inside the heart, there is less risk of damage to the wires during physical activity.
• Young people: Because a young person will have to use this device for a long time, the S-ICD is a better option for them as it has fewer long-term complications.

Can the S-ICD control the heart rate (pacing)?

This is a very important question. Some types of ICDs can help keep the heart beating at a normal rate if it is abnormally slow . This is called pacemaker function.

But current S-ICD devices do not have this pacing capability. That is, the S-ICD cannot correct the heart rate when it is too slow. Its only function is to detect when the heart rate is dangerously fast and deliver a shock to restore it. If you also need pacing, the S-ICD may not be right for you. The best decision is to talk to your doctor about this.

What should I do before this surgery?

If your doctor decides to implant an S-ICD for you, you will be given certain instructions before the surgery. It is very important to follow them exactly.

• You may be asked to stop taking certain medications, such as blood thinners, a few days before surgery.
• On the day of surgery, you will be advised to refrain from eating or drinking for a few hours beforehand.
• Since you may be able to go home the same day after surgery, you should arrange in advance for someone to take you home .

At the hospital, the medical staff will do the following things before the surgery:

• A mark is made on the skin where the device will be placed (usually on the left side of the chest or under the armpit).
• The hair in that area is removed and cleaned thoroughly.
• A cannula (IV line) is inserted into a vein in your arm to give you medication and fluids.
• Antibiotics will be given to prevent infection.
• You will be given anesthesia to prevent pain during the surgery. Most often, it is a type of anesthesia that puts you into a light sleep.
• Your hands may also be secured with a soft bandage to prevent the surgical area from being touched.

What happens during the surgery?

The surgery to implant an S-ICD usually takes about one to two hours. It involves the implantation of two main parts: the generator (this is the main part that contains the battery and circuitry) and the defibrillation lead (this is the wire).

The surgeon will make two or three small cuts in the skin on the left side of your chest or under your armpit. Then, a small 'pocket' is made under the skin and fat layer, just below your rib cage, and the generator is inserted into it. Next, the wire is inserted under the skin, right in the middle of your chest, near the breastbone, and then up the side of your neck.

After everything is installed, we will test this device to see if it is working properly.. While this may sound a little strange, here's what actually happens: Doctors artificially create that dangerous, irregular heartbeat in your heart. Then, the S-ICD detects it and delivers a shock to see if it can restore your heart to normal. At this point, you're under anesthesia, so you won't feel any pain , so there's nothing to worry about.

After confirming that the device is working properly, the incisions made in the skin are closed with stitches.

What happens after the surgery?

After the surgery, you will be taken to a recovery room. The medical staff will watch you closely until the effects of the anesthesia wear off. You may also have an X-ray to check that the device and wires are in place.

Most people are able to go home the same day after surgery. However, because you are under anesthesia, you will not be able to drive, so it is essential to have someone to drive you home.

What are the advantages of an S-ICD?

The main benefit of an S-ICD is that it can prevent sudden cardiac death. In addition, compared to traditional ICDs (TV-ICDs), which are implanted through a wire through a blood vessel, the S-ICD has significantly reduced risks of:

• Cardiac perforation: Damage (perforation) of heart tissue.
• Infections: Severe infections, especially those affecting the inner lining of the heart, such as endocarditis .
• Wire breakage: The wires that run through the blood vessels can break or come loose over time. In that case, they will need to be removed and replaced. This risk is lower with the S-ICD.
• Thrombosis: Blood clot in a blood vessel.

What are the risks and complications of this?

As with any surgical procedure, there are some minor risks associated with implanting an S-ICD. However, these are very rare.

How should I take care of myself while living with an S-ICD?

An S-ICD is like a new friend in your life. Therefore, it is important to learn to live with it. Your doctor will give you detailed instructions on this.

• Go to the clinics on time: The doctor will give you a date to check if the device is working properly, how is the battery, and how is the health of your heart. Be sure to go on those dates.
• Carry an identification card: Always carry a card stating that you have an S-ICD. This will be very important to medical staff in case of an emergency.
• Inform other doctors: When you go to get medicine for any other illness, tell the doctor that you have an S-ICD.
• Be careful when traveling: Consult your doctor, especially when going through metal detectors at places like airports.

How long does the battery last in an S-ICD?

The battery in an S-ICD cannot be recharged. It is built into the device. When the battery runs out, another minor surgery is required to replace the entire generator with a new one.

An S-ICD battery can typically last for about 5 years . However, this time depends on how often the device is triggered (shocked) and its settings. Your doctor will check the battery level each time you visit the clinic.

When should you seek medical advice?

If you experience any of the following symptoms after having the S-ICD implanted, see your doctor immediately or go to the Emergency Department (ETU) of the nearest hospital.

• Chest pain
• Dizziness
• Pus or fluid leaking from surgical incisions
• Redness, swelling, or extreme pain near the incision sites
• Difficulty breathing
• Recurrence of heart symptoms that you had before the S-ICD was inserted

The S-ICD is a very effective and safe technology that can prevent sudden cardiac death. If your doctor has recommended that you have an ICD, talk to him about whether the S-ICD is right for you.