COMPARISON OF IMPLANTATION OF NONTHORACOTOMY DEFIBRILLATORS IN THE OPERATING-ROOM VERSUS THE ELECTROPHYSIOLOGY LABORATORY

Implantable cardioverter-defibrillators (ICDs) with nonthoracotomy lea d systems are widely available, and are implanted either in the electr ophysiology laboratory or the operating room. The purpose of this stud y was to prospectively evaluate the safety and efficacy of nonthoracot omy ICD implantation in an electrophysiology laboratory versus an oper ating room. During a 7-month period, 62 consecutive ICDs with nonthora cotomy lead systems were implanted in patients in an electrophysiology laboratory. During the next 10 months, 110 consecutive ICDs were impl anted in patients in a surgical operating room. All ICD implantations were performed under general anesthesia by electrophysiologists. There were no differences in age (58 +/- 14 vs 62 +/- 12 years, p = 0.06), gender distribution (p = 0.3), frequency of structural heart disease ( 97% vs 97%, p = 0.9), ejection fraction (0.31 +/- 0.15 vs 0.29 +/- 0.1 3, p = 0.3), or presentation with cardiac arrest (65% vs 53%, p = 0.2) between patients undergoing ICD implantation in the electrophysiology laboratory and operating room, respectively. The rate of successful i mplantation and of complications for systems implanted in the electrop hysiology laboratory (95% and 13%, respectively) and in the operating room (98% and 14%, respectively) were similar (p = 0.4 and p = 0.8, re spectively). Specifically, the rate of infection (0% vs 4%, p = 0.3) a nd hematoma formation (2% vs 4%, p = 0.8) were not statistically signi ficantly different. Three patients who had undergone ICD implantation in an operating room died within 30 days. ICDs with nonthoracotomy lea d systems can be implanted with a similarly high rate of success and a cceptable complication rate in the electrophysiology laboratory and in the operating room.