Name of the Procedure:

Electrophysiologic Evaluation of Subcutaneous Implantable Defibrillator (S-ICD)

Summary

This procedure involves testing and evaluating a subcutaneous implantable defibrillator (S-ICD), a device placed under the skin to help prevent sudden cardiac arrest. The evaluation includes testing the device’s ability to detect and correct life-threatening heart rhythms.

Purpose

The main goal is to ensure the S-ICD works correctly by:

• Evaluating defibrillation thresholds (the device’s ability to shock the heart).
• Inducing arrhythmias (abnormal heart rhythms) to test detection and correction.
• Evaluating sensing for arrhythmia termination.
• Programming or reprogramming the device for optimal performance.

Indications

• Patients with a history of life-threatening ventricular arrhythmias.
• Individuals at high risk for sudden cardiac arrest.
• Patients who have recently had an S-ICD implanted.

Preparation

• Patients may be advised to fast for a certain period before the procedure.
• Adjustments to medications, especially blood thinners, may be necessary.
• Pre-procedure diagnostic tests, such as an ECG or blood tests, may be required.

Procedure Description

1. The patient is given a local anesthetic and possibly mild sedation to ensure comfort.
2. An electrophysiologist makes a small incision near the site of the S-ICD.
3. The device is accessed, and various tests are performed:
   • Defibrillation threshold testing to check the device's shock delivery.
   • Inducing arrhythmias to see how well the device detects and corrects them.
   • Evaluating sensing capabilities to ensure proper arrhythmia termination.
   • Programming or reprogramming the S-ICD settings for optimal performance.
4. Once testing is complete, the incision is closed, and the area is bandaged.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is generally performed in a hospital’s electrophysiology lab.

Personnel

• Electrophysiologist (cardiac specialist)
• Nurses
• Anesthesiologist or certified nurse anesthetist, if deeper sedation is required

Risks and Complications

• Infection at the incision site
• Bleeding or bruising
• Discomfort or pain at the procedure site
• Rarely, misfunctioning of the S-ICD or need for reprogramming

Benefits

• Ensures the S-ICD is functioning correctly
• Reduces the risk of sudden cardiac arrest
• Provides peace of mind that the device will respond appropriately in emergencies

Recovery

• Patients can usually go home the same day or the next day.
• Mild soreness or swelling at the incision site.
• Follow-up instructions may include limited physical activity for a few days.
• A check-up appointment may be scheduled to ensure proper healing and device function.

Alternatives

• Manual reprogramming without induction testing
• Wearing an external defibrillator
• Other implantable cardioverter defibrillators (ICDs)

Patient Experience

• Mild discomfort or pressure during the procedure.
• Possible slight pain at the incision site post-procedure.
• Pain management will be available to ensure comfort during recovery.
• Most patients feel reassured knowing their S-ICD is tested and functioning well.