Introduction: The subcutaneous implantable cardioverter defibrillator (S-ICD) is positioned in close proximity of the left mamma. In female patients, this may result in issues, such as limitations in clothing, breastfeeding or self-perception. Moreover, female patients are underrepresented in most large S-ICD studies, thus underexposing these gender-specific issues which may impact their daily life substantially.
Objective: To assess the issues female S-ICD patients are experiencing and provide practical “tips and tricks” for cardiologists and implanters to minimalize gender-specific issues.
Methods: All female patients implanted with an S-ICD in a large tertiary center between February 2009 and November 2018 received a single questionnaire with questions on physical, esthetical and situational issues.
Results: Patients were categorized in three age groups, 18–39 years (n=32), 40–55 years (n=35) and >55 years (n=19). Eighty-four percent of the patients experienced pain after S-ICD implant, almost half (42.9%) of those patients reported extreme pain. After S-ICD implant, self-perception was altered in a small group (20%) and a third of the patients does not wear the same clothing as before. During sexual activity, many female patients actively avoid the touch of their partner on the lead and generator due to discomfort. While no-one reported problems with childbirth or breastfeeding, two patients did experience irritation from the lead during their pregnancies, possibly due to growth of the mammae. The majority of patients (64%) experiences daily discomfort while wearing a bra, specifically with the linings and the sideband (figure A and B). Women prefer a more cranial position of the S-ICD generator with the lower sideband supporting the device (figure C). A position of the S-ICD generator posterior from the lining of the left cup also reduces discomfort.
Conclusion: Female S-ICD patients experience a variety of gender-specific issues with a substantial impact on their daily life. Implanters should provide adequate counseling and use bra position during pre-implant marking to minimize daily discomfort of female patients.