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The significant morbidity associated with transvenous leads led to the development of the newer subcutaneous\u2010ICD (S\u2010ICD). This review discusses the clinical considerations when selecting an ICD for the young patient presenting with out\u2010of\u2010hospital cardiac arrest. The major benefits of TV\u2010ICDs are their ability to pace (antitachycardia pacing [ATP], bradycardia support and cardiac resynchronisation therapy [CRT]) and the robust evidence base supporting their use. Other benefits include a longer battery life. Significant complications associated with transvenous leads include pneumothorax and tamponade during insertion and infection and lead failure in the long term. Comparatively, S\u2010ICDs, by virtue of having no intravascular leads, prevent these complications. S\u2010ICDs have been associated with a higher incidence of inappropriate shocks. Patients with an indication for bradycardia pacing, CRT or ATP (documented ventricular tachycardia) are seen as unsuitable for a S\u2010ICD. If venous access is unsuitable or undesirable, S\u2010ICDs should be considered given the patient is appropriately screened. There is a need for further randomised controlled trials to directly compare the two devices. TV\u2010ICDs are an effective therapy for preventing SCD limited by significant lead\u2010related complications. S\u2010ICDs are an important development hindered largely by an inability to pace. Young patients stand to gain the most from a S\u2010ICD as the cumulative risk of lead\u2010related complications is high. A clinical framework to aid decision\u2010making is presented.<\/jats:p>","DOI":"10.1111\/imj.16259","type":"journal-article","created":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T11:55:33Z","timestamp":1699271733000},"page":"1956-1962","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transvenous versus subcutaneous implantable cardioverter defibrillators in young cardiac arrest survivors"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4286-7580","authenticated-orcid":false,"given":"Matthew B.","family":"Morton","sequence":"first","affiliation":[{"name":"Department of Cardiology Alfred Hospital  Melbourne Victoria Australia"},{"name":"Department of Medicine, Nursing, and Health Sciences Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin 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