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In order to improve the risk\u2010benefit balance of transvenous implantable cardioverter\u2010defibrillator (ICD) systems, a totally subcutaneous ICD (S\u2010ICD) system was developed and approved for use in Europe in 2009. The currently available S\u2010ICD system has undergone several important hardware\u2010 and software\u2010related modifications and improvements over the last 10 years aimed at further improving its efficacy and safety. The results of the PRAETORIAN trial, that is, the first randomized comparison of S\u2010ICD versus transvenous ICDs, of the prospective UNTOUCHED study, and the overall consistent observational data underline that current generation S\u2010ICD systems may be a valid alternative in patients with an ICD indication in whom bradycardia pacing or cardiac resynchronization therapy is not required due to a lower risk of system\u2010related problems. This review summarizes the key differences between the two systems, improvements in hardware components and algorithms over time, as well as most recent clinical evidence regarding the efficacy and safety of the S\u2010ICD.<\/jats:p>","DOI":"10.1111\/pace.14066","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T08:46:05Z","timestamp":1600332365000},"page":"1421-1427","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The subcutaneous ICD for prevention of sudden cardiac death: Current evidence and future directions"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1477-9153","authenticated-orcid":false,"given":"Jan","family":"Steffel","sequence":"first","affiliation":[{"name":"Division of Electrophysiology and Cardiac Devices, Department of Cardiology University Heart Center Zurich  Zurich 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