Background For prevention of sudden cardiac death, the transvenously implantable cardioverter-defibrillator therapy (tv-ICD) is well accepted. The subcutaneous system (S-ICD (R)) is promising in terms of reducing ICD complications. Nevertheless, the impact of the novel generator position on patients' quality of life (QoL) is yet unknown. Objective This study aimed at comparing QoL and posttraumatic stress with both systems. Methods 60 S-ICD (R) and 60 case-controlled tv single-chamber ICD patients were asked to respond to three standardized questionnaires. PDS [screening for posttraumatic stress disorders (PTSD)] and PHQ-D (detection of the most predominant psychological disorders) were used to screen for potential mental comorbidities. The SF-12 questionnaire was used to evaluate physical and mental well-being. Groups were compared in terms of QoL and PTSD. Results n = 42 (70%) pairs were analyzed (n = 30 male, mean age 44.6 +/- 12.2 years). Prior appropriate (p = 0.06) or inappropriate episodes (p = 0.24), ejection fraction (p = 0.28), or underlying cardiac disease did not differ significantly between groups. PDS revealed a PTSD in n = 6 tv-ICD and n = 6 S-ICD (R) patients (14.3%) equally. In the PHQ-D questionnaire, n = 4 tv-ICD and n = 2 S-ICD (R) patients fulfilled criteria for a major depression (p = 0.68). Panic disorders (n = 2 tv, n = 0 S-ICD (R), p = 0.5), and anxiety disorders (n = 3 S-ICD (R), n = 0 tv-ICD, p = 0.24) did not differ between groups. The physical well-being score was 39.9 +/- 12.5 in patients with a tv-ICD compared to 46.6 +/- 9.9 in S-ICD (R) patients (p = 0.01). The mental well-being score was comparable in both groups (tv-ICD 51.8 +/- 10.8 vs. S-ICD (R) 51.9 +/- 10.4, p = 0.95). Conclusions Our case-control study revealed equal or even better physical well-being of patients with the S-ICD (R). PTSD occurred in almost 15% of ICD patients irrespective of the type of system.