Evolution of Extravascular ICD Implantation: Shift Toward Local Anesthesia and Nurse-Led Sedation Without Propofol

We describe the first successful implantation of an extravascular implantable cardioverter-defibrillator (EV-ICD) performed under local anesthetic with nurse-led sedation, without the use of propofol or anesthetic support. The procedure was well tolerated in a carefully selected, motivated patient. Although this is a single case, the patient's experience and procedural metrics were comparable to those performed under general anesthesia. This approach may offer a safe and resource-efficient alternative for individuals for whom general anesthesia is high risk or unavailable. It marks a potential shift in practice, mirroring transitions in S-ICD implantation, which expanded to include nerve block, local anesthesia, and sedation.