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Defibrillators/cardioverters that are permanently inserted (implanted) subcutaneously and connected to leads and electrodes anchored under the skin above but not touching the heart. These defibrillators consist of a hermetically sealed container, including a lightweight battery, electronic circuitry to sense cardiac activity and produce the electrical pulses (shocks), and electrode leads that conduct the myocardial signals to the defibrillator and the electrical defibrillating pulses to the patient, when needed; they usually provide high energy stimuli to compensate for the large path from the electrodes to the heart. Subcutaneous implantable defibrillators/cardioverters are intended to:(1) restore normal rhythm and contractile function in patients who are experiencing ventricular fibrillation or ventricular tachycardia that is not accompanied by a palpable pulse (i.e., defibrillation) or (2) correct noncritical dysrhythmias (e.g., to supraventricular tachycardia, ventricular reentrant tachycardia, atrial flutter and atrial fibrillation) by applying relatively low-level stimuli shocks synchronized to the patient\'s ECG (i.e., cardioversion).
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Leads designed to conduct electrical pacing signals from the pulse generating unit of an implantable subcutaneous defibrillator or defibrillator/cardioverter (i.e., an implantable cardioverter/defibrillator [ICD]) to the heart and conduct the bioelectric cardiac signals back to the unit. These leads typically consist of flexible wires that completely isolated except at the electrode tips; they are positioned in the subcutaneous tissue of the chest above but not touching the heart. The tips include the sensing electrodes and a shock coil. Lead size, connector type, and other characteristics of the leads must be compatible with the subcutaneous implantable defibrillator pulse generator and the therapy prescribed.
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