Introduction:  
The subcutaneous implantable cardioverter defibrillator (S-ICD) is an alternative to a transvenous ICD (TV-ICD) in patients who necessitate prevention from sudden cardiac death without a concurrent need for cardiac pacing.1, 2 Current factors considered by clinicians when determining the appropriate type of ICD to implant include ECG characteristics, body habitus, comorbidities, and patient preference.3-6 In addition, the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guidelines give a class I recommendation to S-ICDs over TV-ICDs in patients with high infectious risk, tricuspid regurgitation, and challenging venous access.7-12 One of the most common indications for extraction or removal of any ICD is device infection. However, other S-ICD patients are later determined to need bradycardia pacing, cardiac resynchronization pacing, or antitachycardia pacing (ATP) for recurrent monomorphic ventricular tachycardia and require device removal and transvenous device implantation. To date, there are limited data on the how often a patient who undergoes implantation of the S-ICD eventually needs to have the system removed and for which reasons. Only two real-world studies have been published on rates of S-ICD extraction with discordant extraction rates from 2.85% to 12.9%.13-14 Better characterizing rates of system extraction may provide insight into the overall risk of the S-ICD in specific patient populations, and indications for S-ICD extraction may further inform device selection. Accordingly, the goal of the present study is to assess incidence of and indications for S-ICD extraction in a large, multihospital healthcare system.