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Introduction The use of subcutaneous implantable cardioverter defibrillators (S-ICD) in patients at risk of sudden cardiac death is increasing. S-ICDs were designed to avoid the potential morbidity and mortality associated with transvenous pacing leads. The ESC guidelines recommend a class IIa indication for S-ICD to be considered as an alternative to transvenous ICD, in patients with an indication for an ICD, when pacing therapy for bradycardia support, cardiac resynchronization or antitachycardia pacing is not needed. Currently, 64% of US centres are using general anaesthetic (GA) for these procedures. Using GA increases the risk of complications both during and after implantation and also presents a resource issue, necessitating an anaesthetist for the duration of the procedure. In this abstract, we report the anaesthesia approach and safety for S-ICD implantation in our centre. 10 S-ICDs have been successfully implanted in our centre between February 2016 and April 2019. The majority of these were male (80%) with an average age of 46.5±12.54 years. Six patients underwent implantation with a combination of conscious sedation with Midazolam and Fentanyl and local anaesthetic. Four patients received regional anaesthesia, provided by our anaesthetics colleagues. Two patients required GA for defibrillation testing (DT). Six patients were successfully discharged on the day of the procedure. Two patients were kept for observation and pain control and both patients who received S-ICDs as inpatients for secondary prevention remained admitted. Conclusion The experience from our centre is that the majority of patients tolerate S-ICD with a combination of local anaesthetic and conscious sedation with or without regional anaesthesia. This minimizes potential complications related to GA and avoids the necessity of having an anaesthetist present for the duration of the procedure, optimizing the use of hospital resources. |
