Subpectoral implantation of a cardioverter defibrillator under local anaesthesia

To evaluate patient acceptability of submuscular implantation of a cardioverter defibrillator (ICD) under local anaesthesia with conscious sedation.

Retrospective review. Patient acceptability in the second half of the study was routinely assessed within 24 hours.

Regional cardiac centre.

45 consecutive patients with either aborted sudden death or haemodynamically unstable ventricular tachycardia were referred for ICD implantation.

A subpectoral implantation technique was employed. Twelve procedures were performed under general anaesthesia. Thirty three patients were sedated with midazolam and diamorphine, and local anaesthesia was achieved with bupivicaine. Ventricular fibrillation for defibrillation threshold testing was induced by alternating current, T wave shock, or ultrarapid burst pacing. Patients were contacted after the procedure to assess acceptability.

32 patients having implantation under local anaesthesia did not recall the surgical procedure. One patient described an awareness of "pushing" as the generator was positioned in the pocket. Seven patients said that the procedure was painless but recalled a test shock, four describing it as mildly uncomfortable. All 33 patients stated that they would be willing to have a second implant under local anaesthesia. Twelve patients who had the implant performed under general anaesthesia had no recollection of the procedure. Mean (SD) total procedure duration was significantly longer in those who had general anaesthesia (93 (16) v 67 (17) minutes; p = 0.0009).

Subpectoral implantation of ICDs may be performed safely with patient acceptability under local anaesthesia with conscious sedation.