A Review of Anesthetic Considerations for Subcutaneous and Extravascular Implantable Cardioverter-Defibrillators

Implantable cardioverter-defibrillators (ICDs) are critical for the prevention of sudden cardiac death due to ventricular arrhythmias and are commonly encountered in the perioperative space. Traditional devices contain transvenous leads that are susceptible to mechanical failure or infection. To reduce these complications, two entirely extravascular ICDs are currently approved for implantation: the subcutaneous Emblem MRI S-ICD and the extravascular Aurora EV-ICD. This article provides an evidence-based review of the indications for use, implantation technique, and anesthetic considerations for these novel systems.