GENERAL ANESTHESIA VERSUS CONSCIOUS SEDATION WITH LOCOREGIONAL ANESTHESIA IN S-ICD IMPLANTATION: A MONOCENTRIC RETROSPECTIVE ANALYSIS

BACKGROUND The transvenous implantable cardioverter-defibrillator (TV-ICD) improves survival in patients at high risk of sudden cardiac death though significant complications may arise, most often from the transvenous leads. In patients not requiring pacing, the subcutaneous ICD (S-ICD) has emerged as a safe and effective alternative for the treatment of life-threatening ventricular arrhythmias. The S-ICD's larger size requires a larger pocket for insertion and peri-procedural lead tunnelling carries high nociceptive potential, resulting historically in 65% of S-ICD implantations being performed under general anesthesia (GA). This study seeks to demonstrate that conscious sedation with locoregional anesthesia (CS) is non-inferior to GA in terms of analgesic efficacy and safety. METHODS AND RESULTS This monocentric retrospective study analyzed all patients having undergone S-ICD implantation at the Montreal Heart Institute between 2016 and 2020, under either CS or GA. Analgesic efficacy in the 24 post-operative hours was evaluated by numeric pain rating scale (NPRS) and by comparing total analgesic medication doses received. Safety was evaluated using logistic regression by comparing the incidence of significant adverse events (AE): hypotension CONCLUSION Conscious sedation with locoregional anesthesia is not only non-inferior, but also superior, to general anesthesia for analgesic efficacy at 24 hours post S-ICD implantation. Moreover, it is a safe alternative to general anesthesia and is associated with shorter implantation time and shorter length of stay post-implantation.