Can a small machine under the skin save lives? Let's talk about the Subcutaneous Implantable Cardioverter Defibrillator (S-ICD)!

Imagine, if your heart suddenly started beating very fast and without any control... that could be a big threat to your life, right? In such a dangerous situation, today we are going to talk about a small, but very powerful technological device that can help save your life. We call this the S-ICD. Don't be afraid, even though the name is a bit complicated, let's understand its functioning simply.

What is this S-ICD?

Simply put, an S-ICD (Subcutaneous Implantable Cardioverter Defibrillator) is a small electronic device that is implanted under your skin, inside your body. It's like a small matchbox. Its main function is to continuously monitor your heart rhythm .

Imagine, if the heart's rhythm suddenly becomes dangerously fast, that is, if it starts beating out of control, this small device detects it. It detects it and immediately gives the heart a small electrical shock. This shock stops the irregular, rapid beating and brings the heart back to a normal rhythm. We call this process defibrillation . This saves someone from death due to sudden cardiac arrest.

How is the S-ICD different from a regular ICD?

You may have heard of regular ICD devices. Once you understand the main differences between the two, you will understand what makes the S-ICD so special.

• Traditional ICD (Transvenous ICD - TV-ICD): In this type, one or more wires ( leads ) connected to the device go through your veins and connect directly to the heart .
• S-ICD: But that's not the case with the S-ICD. Here, the wire is not inserted into a blood vessel. Instead, it is inserted under the skin , in the center of the chest , above the heart.

Who needs this S-ICD?

An S-ICD is usually recommended for people with specific heart rhythm conditions.

In particular, an S-ICD is best suited for people who:

• For those at high risk of infection.
• For those with physical conditions that make it difficult to access the body's blood vessels.
• For those who lead an active lifestyle (e.g. athletes).
• Relatively young people , because they have a longer lifespan , can avoid the complications that traditional ICD wires can cause over time.

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

This is a very important question. No. The current S-ICD devices do not have the ability to control the heart rate, that is, to pace it .

Imagine, if a person's heart rate slows down , a pacemaker is a device that helps maintain it at a normal rate. An S-ICD cannot do that. An S-ICD only gives a shock to the heart rate when it becomes dangerously high , and then returns it to a normal rhythm. So, if you need a pacemaker, your doctor will recommend the most suitable device for you.

What happens before and during this surgery?

This is a non-complicated surgery that usually takes a few hours.

Preparation before surgery

Your doctor will give you the necessary advice.

• You will be asked to stop taking certain medications, such as blood thinners, a few days before surgery.
• You will be asked to fast for a few hours on the day of surgery.
• They tell me to arrange a vehicle to go home after the surgery.

How the surgery is performed

During the surgery, you will not feel any pain. In most cases, you will be given medication to keep you conscious but relaxed (`conscious sedation`).

1. Preparation: The area where the device will be implanted (usually the left side of the chest) is cleaned and hair removed if necessary. Antibiotics are given to prevent infection.

2. Making the incisions: The doctor will make two or three small incisions on the left side of your chest, just below your armpit.

3. Device implantation: The generator (small box) is placed under the skin near the rib cage through one incision. Then, a wire (lead) is placed under the skin through the other incision, running up the middle of the chest (breastbone).

4. Checking: Finally, the doctors check if the machine is working properly. To do this, they artificially create an abnormally fast heartbeat in your heart and then give it a shock from the S-ICD to correct it. Don't worry, you will still be sedated during this time, so you won't feel anything.

5. Stitching the wounds : After everything is completed successfully, the incisions are stitched closed.

After surgery, you will be taken to a recovery room for observation for a while. Most people can go home the same day.

What are the benefits and risks of an S-ICD?

Like any medical procedure, an S-ICD has benefits and minor risks.

When should you seek medical advice?

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

• Chest pain
• Dizziness
• Difficulty breathing
• Redness, swelling, or pain at the incision site
• Pus or other fluid draining from the cut
• Recurrence of symptoms that were present before the S-ICD was inserted