Safety and potential cost savings of same-setting electrophysiologic testing and placement of transvenous implantable cardioverter-defibrillators

Background: Separately, electrophysiologic study (EPS) and placement of a t ransvenous implantable cardioverter-defibrillator (ICD) can be performed sa fely in the majority of patients. The safety and potential cost savings of same-setting procedures have not been evaluated. Hypothesis: Electrophysiologic study and placement of transvenous ICDs can be performed safely in the same setting at reduced cost. Methods: In all, 160 (mean age 65 +/- 10 years, 75% men) and 41 (mean age 6 6 +/- 11 years, 73% men) consecutive patients who underwent same- versus se parate-setting procedures, respectively, were prospectively evaluated. Results: The two groups had similar clinical characteristics and indication s for EPS and ICD therapy. Complications, occurred in eight patients (5.0%, 95% confidence inter vat [CI] 2.3-10.3) who had same-setting procedures (o ne hypotension during ICD testing, one pocket hematoma, two lead dislodgmen ts, two pneumothoraces, one stroke, and one infection) and in two (4.9%, CI 0.60-16.5) who had separate-setting procedures (one pocket hematoma and on e infection). There were no procedure-related deaths or long-term ICD-relat ed complications in either group. The mean time from ICD implantation to ho spital discharge was similar in the two groups (2.5 +/- 2.4 vs. 2.7 +/- 2.2 days, p = NS). The combined procedure cost was higher in patients who had separate-setting., procedures ($12,403 +/- 1,386 vs. $10,242 +/- 2,256, p = <0.001), who incurred an additional hospital cost of $2,121 +/- $2,125 for the waiting period (1.7 +/- 1.6 days) between EPS and ICD implantation. Conclusions: In patients deemed candidates for ICD therapy based on EPS res ults, placement of transvenous defibrillators in the same setting as EPS is as safe as separate-setting procedures and, if adopted, could further redu ce the cost of providing ICD therapy.