Background: The S-ICD has become a potential first option for prevention of sudden cardia death in different constellations. Especially in patients suffering from an infection of a tv-ICD, reimplantation of an S-ICD seems attractive to reduce risks of recurrent infection and to prevent further complications. However, there are only limited data analysing the conversion from a transvenous to a S-ICD and e.g. in case of infections there is currently only a reluctant recommendation in the ESC guidelines. Thus, we present data from our large tertiary centre to report long-term follow-up experience after change of the ICD system.

Methods and results: All patients who underwent conversion from a transvenous to S-ICD (n=53) from our large-scaled S-ICD registry (n=383 patients) were included. Baseline characteristics and follow-up data were analysed over a follow-up of 38±36 months. 72% of patients were male, mean age was 49.7±17.6 years and mean left ventricular ejection fraction was 49.0±13.4%. Reasons for explantation of the tv-ICD were infections (40%), lead defects (40%) and/or oversensing (30%). There were no infectious complications or lead defects of the subcutaneous lead during follow-up, oversensing occurred in 7.5%. A conversion back to a transvenous ICD was performed in two patients (ineffective shock, refractory oversensing).

Conclusion: The S-ICD was found to be an appropriate option in case of malfunction or infection of a tv-ICD if there was no need for antibradycardia pacing. Changes back to tv-ICDs are rare and complications are low, especially no recurrent infections were observed.