The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Insertion of a subcutaneous implantable cardioverter defibrillator for prevention of sudden cardiac death in April 2013. NICE is currently updating this guidance. The new guidance will be published shortly. Until then the NHS should continue to follow the recommendations outlined in the current version of the guidance. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure review and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status In progress
Process IP
Description An entirely subcutaneous implantable cardioverter defibrillator (ICD) differs from a transvenous ICD in that a single lead is placed subcutaneously. The lead comprises 2 sensing electrodes and a shocking coil. The ICD senses cardiac signals, but the lead is not directly attached to the heart. Also, unlike a conventional transvenous ICD, the subcutaneous device is not designed to provide long-term pacing. The implantation procedure is carried out with the patient under general anaesthesia, or with local anaesthesia and sedation. Implantation is guided by anatomical landmarks without the use of fluoroscopy or other medical imaging. A subcutaneous pocket for the generator is created on the left side of the chest. The lead is tunnelled subcutaneously from the pocket to a small incision at the lower end of the sternum. Then, it is tunnelled to a second small incision at the upper end of the sternum and secured so that the sensing electrodes and shocking coil lie alongside the sternum. The lead is then connected to the generator in the pocket. Finally, the incisions are closed and the sensing, pacing and recording functions of the ICD are adjusted using an external programmer. Ventricular fibrillation is induced to test that the ICD can appropriately detect and correct it.

Timeline

Key events during the development of the guidance:

Date Update
25 August 2017 - 25 September 2017 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance