First Experience With Extravascular Implantable Cardioverter-Defibrillator Under Deep Sedation

Area of Science:

• Cardiology
• Anesthesiology
• Medical Devices

Background:

• The Extravascular Implantable Cardioverter-Defibrillator (EV-ICD) offers defibrillation and anti-tachycardia pacing (ATP) while avoiding transvenous lead complications.
• Current EV-ICD implantation protocols often recommend general anesthesia (GA), which carries risks and resource implications.

Purpose of the Study:

• To evaluate the feasibility, safety, and procedural efficiency of EV-ICD implantation under cardiologist-administered deep sedation with noninvasive ventilation (DS-NIV).
• To compare DS-NIV with standard GA for EV-ICD procedures.

Main Methods:

• Retrospective analysis of 24 consecutive EV-ICD implantations.
• Patients received either GA (n=14) or DS-NIV (n=10) using a propofol-ketamine protocol managed by cardiologists.
• Assessment of peri-procedural safety, workflow, anesthesia characteristics, and early device performance.

Main Results:

• No anesthesia-related complications were observed in either group.
• The DS-NIV group showed significantly shorter wheels-to-incision times (45 vs. 70 min, p=0.022) and required fewer vasopressors (60% vs. 100%, p=0.024).
• Procedural duration, defibrillation testing success, and electrical parameters were comparable between groups; no inappropriate therapies were delivered during follow-up.

Conclusions:

• Cardiologist-administered DS-NIV is a feasible and safe anesthesia option for EV-ICD implantation.
• DS-NIV offers improved workflow efficiency compared to GA, supporting its use in experienced centers.
• This approach may enhance accessibility to EV-ICD therapy.