Concierge cardiology · London
Subcutaneous ICD (S-ICD) implant - private in London.
A defibrillator that sits entirely under the skin. Generator in the mid-axillary line, a single lead tunnelled to the breastbone, and nothing inside the heart or veins. The Boston Scientific EMBLEM S-ICD, implanted by a consultant electrophysiologist in a proper theatre.
Why patients choose us
- 01
A consultant electrophysiologist, in a proper theatre
Not a general cardiologist. A named EP consultant who implants the Boston Scientific EMBLEM S-ICD routinely, in a hybrid theatre with anaesthetic cover.
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The right device for your risk
S-ICD, transvenous ICD, and CRT-D all on the table. Which one fits your rhythm and your life is settled before you commit.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private S-ICD implant costs in London.
Indicative all-inclusive ranges across our partner theatres: device, hospital stay, electrophysiologist and anaesthetist. NHS funding applies where NICE and BHRS criteria are met. Send the details and we quote firm figures.
In short
An EMBLEM S-ICD in our network: £22,000-£38,000, home the next morning.
| Procedure | Indicative range | Typical duration | Stay |
|---|---|---|---|
| Subcutaneous ICD (Boston EMBLEM S-ICD) implant | £22,000-£38,000 | 60-90 min | Overnight |
| S-ICD screening ECG (three-vector template test) | £150-£300 | 30 min | Same visit |
| EP consultation and SCD-risk assessment | £250-£450 | 45 min | Same visit |
| Device check and remote monitoring set-up | £150-£300 | 20 min | Same visit |
| Generator change at end of life | £16,000-£22,000 | 45-60 min | Same day |
| Transvenous ICD (single or dual chamber) | £20,000-£32,000 | 60-90 min | Overnight |
Prices vary by centre, by which electrophysiologist does the case, and by length of stay. We come back with a firm quote within one working day.
The problem
The right device, the right patient, the right advice.
The S-ICD is a superb device for the right patient - and the wrong device for the wrong one. The mistakes we see are S-ICDs implanted in patients who needed anti-tachycardia pacing, or transvenous ICDs implanted in patients who should have kept their veins clear. We fix that before you commit.
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Young, and facing decades of device therapy?
No leads in the veins means no lead extractions later in life. That matters more with every decade you look ahead.
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Worried about lead infection?
Prior endocarditis, dialysis or immunosuppression - the S-ICD keeps all hardware outside the heart and vessels.
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Want it done properly?
A named electrophysiologist, a BHRS-accredited theatre, a proper screening ECG, and honest advice on whether an S-ICD or a transvenous device fits your risk.
The journey
From enquiry to remote monitoring - what happens, in order.
One electrophysiologist from first message to long-term device follow-up.
Phase 1 · Before your implant
Concierge, off-stage for you
Phase 2 · On the day
A few hours in theatre, one night in hospital
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Diagnosis, ECG, echo and any family history of sudden cardiac death, plus whether an ICD has already been recommended by your cardiologist.
- 02
Before
We come back with a recommendation
Within one working day: whether an S-ICD fits, whether a screening ECG will pass the S-ICD template, and an indicative price. If a transvenous ICD or CRT-D is more appropriate, we say so.
- 03
Before
We arrange the implant
Usually within one to two weeks. Blood thinners are reviewed with the EP team and never stopped without advice. Fasting instructions and skin-prep guidance are sent to you.
- 04
On the day
Arrival at the theatre
Admission, consent and a chat with the electrophysiologist and anaesthetist. General anaesthesia or deep sedation - your choice, discussed at consent.
- 05
On the day
The implant itself
60 to 90 minutes. Generator pocket in the mid-axillary line, single lead tunnelled to a parasternal position. Defibrillation threshold testing (or a PRAETORIAN score) at the end.
- 06
On the day
Overnight for observation
One night in hospital is usual. A chest X-ray in the morning, a device check, and a shoulder sling for the first 1-2 weeks.
- 07
After
Recovery and device check
Back to desk work in 1-3 weeks, driving per DVLA rules, and full sport at 6-8 weeks. Device check at 6 weeks, then remote monitoring every 3-6 months.
Typical end-to-end: 1-2 weeks from enquiry to implant. Return to desk work: 1-3 weeks. Full sport: 6-8 weeks.
When it helps
When a subcutaneous ICD is the right step.
The situations we see most, plus the red flag that means an emergency rather than an appointment. The S-ICD only shocks - if you also need pacing, we say so.
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Hereditary cardiomyopathy
HCM, ARVC, long-QT (LQTS) or Brugada syndrome with a primary-prevention indication - the S-ICD spares the venous system for a lifetime of devices.
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Survived sudden cardiac arrest
Secondary-prevention ICD after a VF/VT arrest with no need for anti-tachycardia pacing or bradycardia backup.
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Young patients
Children, adolescents and young adults facing decades of device therapy - no leads in the veins, no lead extractions later in life.
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Limited or difficult venous access
Congenital heart disease, prior subclavian occlusion, mechanical tricuspid valve, or upper-limb DVT - the veins to the heart are left completely untouched.
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Previous endocarditis or lead infection
A prior transvenous lead infection or bloodstream infection - the S-ICD keeps all hardware outside the heart and vessels.
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Dialysis patients
End-stage renal disease on haemodialysis - preserving central veins for fistulas and avoiding lead-related infection risk.
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Immunosuppression
Transplant recipients or long-term immunosuppression, where transvenous lead infection carries a much higher morbidity.
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Red flag: aborted cardiac arrest
A witnessed collapse with a shockable rhythm is an emergency - same-day A&E, not a clinic booking. Once stable, the ICD route can be discussed properly.
Device options
S-ICD compared with the alternatives.
The S-ICD keeps every wire outside the heart and vessels - MRI-conditional, no lead extraction to worry about, no endocarditis on a lead. What you give up is anti-tachycardia pacing and bradycardia backup. Here is when each device wins.
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Boston Scientific EMBLEM MRI S-ICD
The only subcutaneous ICD on the market. Generator sits in the mid-axillary line, a single lead tunnelled to a parasternal position. Delivers up to 80J for VF/VT. MRI-conditional at 1.5T.
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Transvenous single-chamber ICD (VVI)
Standard ICD with one lead in the right ventricle - still the right answer where anti-tachycardia pacing or bradycardia backup is needed.
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Transvenous dual-chamber ICD (DDD)
RA and RV leads for shock therapy plus dual-chamber pacing - preferred where sinus node dysfunction or AV block coexist with an ICD indication.
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CRT-D (biventricular defibrillator)
Cardiac resynchronisation plus shock therapy for heart failure with a wide QRS and low ejection fraction. An S-ICD cannot deliver CRT.
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Leadless pacemaker (Micra / Aveir)
Sometimes paired with an S-ICD in select cases to add bradycardia support without adding transvenous leads. Discussed only where the indication is clear.
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Wearable cardioverter defibrillator (LifeVest)
A short-term external option while a decision is being made, or during a period of temporary risk after a large MI or new cardiomyopathy diagnosis.
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Extravascular ICD (Medtronic EV-ICD)
A newer substernal lead alternative - not yet routine in UK private practice. We flag it where relevant but do not recommend it lightly.
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No ICD - medical management
Where the risk of sudden cardiac death is low, or where the patient prefers not to proceed. We support informed refusal as readily as informed consent.
Where it is done in London
A small panel of electrophysiologists, at the centres that do this properly.
Consultant electrophysiologists at BHRS-accredited centres across London - including Royal Brompton, Bart's Heart Centre Private, HCA Wellington, King's Private and Guy's and St Thomas' Private. Introductions are made privately, once we understand your rhythm.
Selection criteria
How we choose every electrophysiologist in our network.
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Consultant electrophysiologists with high S-ICD implant volume
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BHRS-accredited implanting centres with on-site cardiac surgery cover
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Screening ECG and PRAETORIAN scoring done properly before consent
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Remote monitoring and long-term device follow-up included
Safety and recovery
What to expect afterwards - honestly.
An S-ICD trades one set of risks for another. You avoid every complication that involves a lead inside the heart or veins. What remains is a pocket, a tunnelled lead, and a larger generator than a transvenous ICD.
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General anaesthesia or deep sedation
Your choice, discussed at consent. GA is more common for S-ICD than for transvenous devices because of the tunnelling. An anaesthetist is present throughout.
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No leads in the heart or veins
The single defibrillator lead sits entirely under the skin, parasternally. No risk of lead perforation, lead-tip endocarditis, tricuspid regurgitation, or subclavian vein occlusion.
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Larger device than a transvenous ICD
The generator is bigger and sits in the mid-axillary line rather than below the collarbone. A slim patient will feel and see it more; body-mapping at planning helps site it well.
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No anti-tachycardia pacing, no bradycardia backup
The S-ICD only shocks. It cannot terminate monomorphic VT with painless pacing bursts, and it cannot pace for slow rhythms - if you need either, a transvenous ICD or CRT-D is the right answer.
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Battery life 5-7 years
Shorter than a transvenous ICD (typically 8-10 years). Remote monitoring flags depletion months in advance and generator changes are straightforward.
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Pocket and wound care
A mid-axillary pocket needs 4 weeks to settle. Sling for 1-2 weeks, no heavy lifting for 4 weeks, wound checks at 2 and 6 weeks. Infection risk is lower than transvenous but not zero.
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MRI-conditional at 1.5T
EMBLEM S-ICD is MRI-conditional under specific scanning protocols. Scans are booked at MRI-capable centres with device programming immediately before and after.
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What it feels like when it shocks
Patients describe an appropriate shock as a hard, sudden thump to the chest - unpleasant but brief. Inappropriate shocks (T-wave oversensing) have been reduced by the current SMART Pass algorithm.
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Red flags
Fever, wound leaking, swelling that grows, chest pain, breathlessness or blackouts after implant - call the clinic or A&E the same day.
Reading your implant note
Your implant note in four parts. Read the last one first.
Whichever device is implanted, the note the electrophysiologist sends you keeps to the same shape.
A quiet reminder
Device programming language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your device check, just ask.
- 01 Header
Indication and device chosen
Why the ICD was implanted - primary or secondary prevention, cardiomyopathy type, LVEF - and confirmation that the EMBLEM S-ICD was implanted.
- 02 Technique
Pocket, lead position and DFT testing
Two-incision or three-incision technique, generator pocket in the mid-axillary line, parasternal lead position, and defibrillation threshold testing (or PRAETORIAN score) at the end.
- 03 Findings
Sensing vector and complications
Which sensing vector was chosen (primary, secondary, alternate), any concerns about T-wave oversensing, and any wound, tunnelling or anaesthetic issue.
- 04 Impression
Programming, follow-up and remote monitoring
Read this first: shock zones (conditional and standard), SMART Pass on/off, when to return for the 6-week check, and the remote monitoring plan for the years ahead.
Recognised by major UK insurers
Cover for S-ICD implantation varies by insurer - usually funded where NICE and BHRS criteria are met and the indication is clearly documented. We confirm cover before booking.
Frequently asked
Everything we get asked about the subcutaneous ICD.
Quick answers on MRI, battery life, sport, driving, insurance and what a shock feels like.
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Is an S-ICD MRI safe?
The Boston Scientific EMBLEM S-ICD is MRI-conditional at 1.5 Tesla under a specific scanning protocol. Scans are booked at MRI-capable centres with the device programmed to an MRI-safe mode immediately before, and re-programmed afterwards. Certain body regions and 3T scanners still have restrictions - the EP team will confirm before any scan.
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How long does the S-ICD battery last?
Typically 5 to 7 years, shorter than a transvenous ICD (which lasts 8 to 10 years) because the shocks are delivered from outside the heart and need more energy. Remote monitoring flags depletion months in advance and the generator change is a shorter, single-pocket procedure.
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Can I still swim and play sport?
Yes. Swimming, running, cycling, tennis, golf and most gym work resume at 6 to 8 weeks. Contact sports (rugby, boxing, martial arts) are usually avoided because of the risk of direct trauma to the device. Some athletes actually prefer the S-ICD over a transvenous ICD because there is no lead crossing the shoulder joint.
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What are the DVLA driving rules after an S-ICD?
For a primary-prevention ICD you must stop driving for 1 month for a Group 1 (car) licence. For a secondary-prevention ICD (after a cardiac arrest or sustained VT) it is 6 months off Group 1 driving. Group 2 (HGV/PSV) licences are usually permanently barred once any ICD is implanted. You must notify the DVLA.
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Will private medical insurance cover an S-ICD?
Cover for S-ICD implantation varies by insurer, but Bupa, AXA Health, Vitality, Aviva, WPA, Cigna and Healix will usually fund it where the indication is clearly documented and NICE / BHRS criteria are met. We confirm cover in writing before booking.
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What does it feel like if the S-ICD shocks me?
Patients describe an appropriate shock as a hard, sudden thump to the chest - unpleasant but brief, and it means the device has done its job. Inappropriate shocks (usually from T-wave oversensing) have been reduced substantially by the SMART Pass algorithm on the current EMBLEM generator. If you receive any shock, you should contact the EP team the same day.
Related treatments
Looking for something else?
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Leadless pacemakers
Micra AV, Micra VR and Abbott Aveir - self-contained pacing without a chest pocket or leads.
Learn more -
Conduction system pacing
His-bundle and left bundle branch area pacing - a more physiological pacing option.
Learn more -
Atrial fibrillation
Rate, rhythm, stroke risk and when ablation is the answer.
Learn more -
Cardiac arrhythmia
The full range of heart-rhythm problems and their private treatment pathways.
Learn more
Ready when you are
A named electrophysiologist for your S-ICD, in one working day.
Tell us what is going on. We come back with the right consultant, the right centre, and an honest recommendation on whether an S-ICD, a transvenous ICD or a CRT-D fits your rhythm.