SAFETY OF IMPLANTATION OF A CARDIOVERTER-DEFIBRILLATOR WITHOUT GENERAL-ANESTHESIA IN AN ELECTROPHYSIOLOGY LABORATORY

Implantable cardioverter-defibrillators (ICDs) have conventionally bee n implanted in an operating room under general anesthesia. This study was performed to evaluate ICD implantation without general anesthesia by 2 electrophysiologists in an electrophysiology laboratory. Between February and September 1994, 27 consecutive patients (22 men and 5 wom en, mean age 59 +/- 15 years) who underwent ICD implantation by 2 elec trophysiologists were included in this study. Fourteen patients receiv ed biphasic waveform ICDs, and the remaining 13 had monophasic wavefor m devices. All patients received ed local anesthesia and intravenous s edation for implantation. Implantation was successful in 23 of 27 pati ents at first attempt (11 of 11 with biphasic and 12 of 16 with monoph asic waveform ICDs, respectively). Of 4 patients in whom implantation was initially unsuccessful, 3 subsequently received biphasic devices a nd 1 had improved defibrillation threshold (less than or equal to 26 J ) on repeat testing after amiodarone withdrawal. Mean implantation tim e was 128 +/- 51 minutes, with 132 +/- 35 minutes under sedation. Pati ents who received biphasic versus monophasic waveform ICDs had no sign ificant differences in mean sedation or implantation time. Minor compl ications occurred in 2 patients (7%): 1 minor abdominal pocket hematom a and 1 incision-site cellulitis. Mean time from implantation to disch arge was 2.5 +/- 2.1 days. During late follow-up (n = 23; mean 12.4 +/ - 5.8 weeks), all devices were functioning appropriately. In conclusio n, this report demonstrates that ICD implantation can be safely perfor med by a team of 2 using local anesthesia and intravenous sedation. A rate of success and a tow rate of complication could expected in an el ectrophysiology laboratory with quality fluoroscopy and experienced pe rsonnel.