Heart 1998;79:253-255 ( March )
Subpectoral implantation of a cardioverter defibrillator under local anaesthesia
University Department of Cardiology, Manchester
Heart Centre, Manchester Royal Infirmary, Oxford Road,
Manchester M13 9WL, UK
Correspondence to: Dr Fitzpatrick.
Accepted for publication 30 October 1997
Objective
To evaluate patient acceptability of
submuscular implantation of a cardioverter defibrillator (ICD) under
local anaesthesia with conscious sedation.
DesignRetrospective review. Patient acceptability
in the second half of the study was routinely assessed within 24 hours.
SettingRegional cardiac centre.
Patients45 consecutive patients with either
aborted sudden death or haemodynamically unstable ventricular
tachycardia were referred for ICD im- plantation.
InterventionsA subpectoral implantation technique
was employed. Twelve procedures were performed under general
anaesthesia. Thirty three patients were sedated with midazolam and
diamorphine, and local anaesthesia was achieved with bupivicaine.
Ventricular fibrillation for defibrillation threshold testing was
induced by alternating current, T wave shock, or ultrarapid burst
pacing. Patients were contacted after the procedure to assess acceptability.
Results32 patients having implantation under
local anaesthesia did not recall the surgical procedure. One patient
described an awareness of "pushing" as the generator was positioned
in the pocket. Seven patients said that the procedure was painless but
recalled a test shock, four describing it as mildly uncomfortable. All
33 patients stated that they would be willing to have a second implant
under local anaesthesia. Twelve patients who had the implant performed under general anaesthesia had no recollection of the procedure. Mean
(SD) total procedure duration was significantly longer in those who had
general anaesthesia (93 (16) v 67 (17) minutes; p = 0.0009).
ConclusionsSubpectoral implantation of ICDs may
be performed safely with patient acceptability under local anaesthesia
with conscious sedation.
© 1998 by Heart
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