Can we implant cardioverter defibrillator under minimal sedation?

Aim In a prospective study, we tested the feasibility of implantable cardioverter-defibrillator (ICD) implantation under local anaesthesia (LA) with minimal sedation (MS) vs. short general anaesthesia (SGA) for defibrillation test (DT).

We implanted ICDs in 118 patients between October 2002 and November 2003. Surgery was performed under LA with MS. Depending on the day of admission, patients had DT without SGA with a shock delivered when patient is unconscious (MS group, n = 73) or with short general anaesthesia (SGA group, n = 45). The patients were asked to rate the intensity of pain on a 10-point visual analogue scale (VAS) at the end of the implantation procedure and for the patient of MS group just after DT (VAS-DT). Visual analogue scale was not influenced by the type of anaesthesia (MS vs. SGA). Univariate analysis showed that NYHA >III, 3 leads implanted and an incomplete understanding of the explanation on the procedure were risk factors of VAS >4. Only understanding of the explanation on the procedure has an influence on pain in multivariate analysis.

ICD implantation under MS even for DT is feasible and acceptable for the patient.