Electrophysiologist-implanted transvenous cardioverter defibrillators using local versus general anesthesia

Area of Science:

• Cardiology
• Electrophysiology
• Anesthesiology

Background:

• Transvenous implantable cardioverter-defibrillators (ICDs) are increasingly smaller and safer to implant.
• General anesthesia has been the standard for ICD implantation, potentially adding complexity and risk.
• Local anesthesia with deep sedation for defibrillation threshold (DFT) testing may simplify procedures.

Purpose of the Study:

• To assess the feasibility of using local anesthesia with deep sedation for ICD implantation.
• To compare local anesthesia with general anesthesia during transvenous ICD implantation procedures.
• To evaluate procedural outcomes and complications associated with each anesthesia technique.

Main Methods:

• A retrospective study of 90 consecutive transvenous ICD implantations performed by electrophysiologists.
• Group I (n=40) received general anesthesia; Group II (n=50) received local anesthesia with deep sedation for DFT testing.
• Data collected included procedural duration, DFT, pace-sense thresholds, complications, and patient discharge times.

Main Results:

• No significant differences were observed in defibrillation threshold (DFT) or pace-sense thresholds between groups.
• Procedural duration was significantly shorter in the local anesthesia group (2.1 hours) compared to the general anesthesia group (2.9 hours).
• Complication rates were similar (7%), with some potentially anesthesia-related events in the general anesthesia group.

Conclusions:

• Local anesthesia with deep sedation is a feasible alternative for transvenous ICD implantation.
• This technique can expedite procedures and potentially reduce costs and complications associated with general anesthesia.
• Electrophysiologists can safely perform ICD implantations using local anesthesia in the electrophysiology laboratory.