SUBCUTANEOUS SINGLE-INCISION IMPLANTATION OF CARDIOVERTER-DEFIBRILLATORS UNDER LOCAL-ANESTHESIA BY ELECTROPHYSIOLOGISTS IN THE ELECTROPHYSIOLOGY LABORATORY

Implantable cardioverter-defibrillators (ICDs) have traditionally been implanted at the operating room under general anesthesia. Endocardial lead systems and downsized devices allowed implantation by electrophy siologists in the pectoral region. The present study evaluates the saf ety and efficacy of subcutaneous ICD implantation performed entirely b y electrophysiologists using a single-incision approach for lead inser tion and device placement under local anesthesia, between June 1996 an d May 1997, 51 of 52 consecutive patients (41 men and 10 women, mean a ge 58 +/- 9 years) underwent ICD implantation at the electrophysiology laboratory, Local anesthesia and intravenous sedation were administer ed to ail patients, After transvenous lead positioning by either venot omy of the left cephalic vein (n = 16) or puncture of the left subclav ian vein (n = 35), all ICDs were implanted subcutaneously at the left subclavicular region, Fifty procedures (98%) were successful at first attempt, The mean implantation time was 76 +/- 22 minutes and the mean fluoroscopy time was 7.5 +/- 5.2 minutes, patients received ICD devic es generating biphasic waveforms. The mean defibrillation threshold wa s 11 +/- 3 J. Procedure-related complications occurred in 5 patients ( 10%): 1 lead dislocation, 2 pocket hematomas, and a pneumothorax requi ring drainage, Mean time from implantation to hospital discharge was 1 .8 +/- 1.2% days. During follow-up (38 +/- 14 weeks), all devices were operating appropriately and no major complications occurred. In concl usion, this report demonstrates that a single-incision subcutaneous te chnique for ICD implantation can be safely and successfully performed by electrophysiologists using local anesthesia and intravenous sedatio n, The high success rate, low complication occurrence, and short impla ntation and fluoroscopy times make this cost-effective technique in th e electrophysiology laboratory the method of choice. (C) 1998 by Excer pta Medica, Inc.