LOCAL-ANESTHESIA VERSUS GENERAL-ANESTHESIA FOR CARDIOVERTER DEFIBRILLATOR IMPLANTATION/

It has been shown recently that unipolar implantable cardioverter/defi brillators (ICD) can safely be implanted under local anesthesia (LA) w ith mild sedation only for defibrillation threshold (DFT) testing, and that the procedure is well tolerated. The aim of the present study wa s to compare LA in combination with mild sedation to general anesthesi a (GA) in DFT testing and ICD implantation. Forty patients were assign ed to two groups: in the first 20 consecutive patients the ICD was imp lanted under GA, and in the subsequent 20 patients under LA. There was no significant difference in age, body weight, underlying disease, le ft ventricular ejection fraction, and NYHA-classification between the two groups. DFT was 13.7 +/- 5.5 J under LA versus 10.7 +/- 4.7 J unde r GA (n.s.). Under LA in all 20 patients a sufficient DFT ((2) 24 J) w as achieved, whereas in 2 out of the 20 patients under GA the unipolar system was ineffective (n.s.) and a bipolar device had to be implante d. For DFT testing 7.5 +/- 2.8 shocks had to be applied in patients un der GA versus 6.2 +/- 1.3 shocks under LA (n.s.). Mean heart rate, art erial oxygen saturation, and mean arterial blood pressure remained sta ble throughout DFT testing, irrespective of the type of anesthesia use d. The duration of the surgical procedure was 62 +/- 16 min under GA a nd 60 +/- 14 min under LA (n.s.), however, the entire implantation pro cedure was significantly longer in patients under GA than in patients under LA (124 +/- 24 min and 97 +/- 22 min, respectively, p<0.005). Th ere were no complications in either group and the procedure was well t olerated. With the use of LA the costs of anesthesia were reduced by 7 2 %. Conclusions: LA in combination with mild sedation is as safe and well tolerated as GA in ICD implantation. Lidocaine used for LA does n ot adversely affect DFT. Device implantation in a pacemaker-like appro ach results in a significant reduction in total procedure time and cos ts, and will provide the patient with easier procedure scheduling.