The subcutaneous implantable cardioverter-defibrillator: should patients want one?

The subcutaneous implantable cardioverter-defibrillator is a novel device that does not require insertion of a transvenous lead; rather, it delivers 80-J transthoracic shocks via a subcutaneous pulse generator implanted in the left lateral chest and a subcutaneous left parasternal lead-electrode. It recently received approval by U.S. Food and Drug Administration panel on the basis of a 180-day study in 330 patients. However, it has not been shown to be non inferior to current implantable cardioverter-defibrillators, and it does not provide either anti-tachycardia or bradycardia pacing. Thus, is this technology ready for widespread application? Specifically, should a patient want one?