Sir,—In a recent issue, Lipscomb and colleagues1 reported on the implantation of cardioverter defibrillators (ICD) under sedation and local anaesthesia. In July 1997 we also began implantation of ICD devices under local anaesthesia, in conjunction with intravenous sedation using non-anaesthetic agents, in response to logistical problems in obtaining general anaesthetics coupled with the development of smaller devices. We have prospectively collected data on 34 consecutive implantations—28 men and six women (mean age 61, range 30–76) with mean left ventricular ejection fraction of 32% (range 15–70) of whom 29 had ischaemic heart disease. The …