Open Access

916<br />The impact of anesthesia choice on subcutaneous implantable cardioverter defibrillator outcomes: acute and one year results from the post approval study

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Date: 18 June 2020
Journal: EP Europace Journal , Volume 22 , Issue Supplement_1
Authors: J. Aasbo , J. Dinerman , G. Mark , M. Burke , M. El-Chami , P. Belott , J. Mackall , M. Gold

ESC Journals

AbstractFunding Acknowledgements

This study was financially supported by Boston Scientific

The influence of anesthesia technique on the outcomes of subcutaneous implantable cardioverter defibrillator (SICD) implantation has not been prospectively evaluated.

The aim of the present analysis was to characterize the effect of anesthesia choice acutely and over a year follow-up in the large "real-world" cohort of the SICD Post Approval Study (SICD-PAS).

Patients received either general anesthesia (GA), conscious sedation (CS), or monitored anesthesia care (MAC) at the implanting physicians" discretion.  Acute results and complications over one year were compared between GA, CS and MAC.

1,631 patients were studied.  64.3% received GA , 29.2% received CS and 6.6% received MAC.  Procedure times were shortest for MAC versus GA and CS (Table 1).  Cross-over from CS and MAC to GA occurred in 2.9% and 1.9% of procedures, respectively.  The mean left ventricular ejection fraction (LVEF) was lower in the MAC cohort compared with GA and CS.  GA patients were less often discharged the same day than CS and MAC.  Patients who had GA were more likely to have had intra-operative DFT testing, while successful DFT testing at implant did not differ among groups (Table 1).  At one year, freedom from total complications did not differ between groups (93.3% for GA, 92.9% for CS and 87.8% for MAC, p = 0.095) nor did freedom from inappropriate shocks (94% for GA, 94.2% for CS, 88.9% for MAC, p = 0.138) nor appropriate shocks (95.8% for GA, 95% for CS, 95% for MAC, p = 0.747).

All three anesthesia techniques had similar acute and one year outcomes but, despite having worse LVEF, patients who received MAC had shorter procedure times and infrequently required conversion to GA.  GA was associated with higher rates of next day patient discharge.  These results suggest that MAC may be preferred for the majority of patients. This observation should be confirmed with prospective trials.

Table 1:Characteristics and Outcomes

ParameterConscious SedationGeneral AnesthesiaMonitored Anesthesia CareP value
Gender[%(N/Total)]Male68.1 (324/476)69.3 (726/1048)66.4 (71/107)0.77
Age (years)mean ± SD54 ± 1553 ± 1554 ± 130.61
Body Mass Indexmean ± SD30 ± 730 ± 829 ± 60.41
Creatinine (mg/dL)mean ± SD2 ± 22 ± 42 ± 20.43
LVEF (%)mean ± SD33 ± 1532 ± 1526 ± 9<0.001
Procedure Time (min)mean ± SD85 ± 4275 ± 3365 ± 30<0.001
Same Day Discharge%70.3%64.3%72.6%0.03
DFT Attempted%84%89.1%81.3%0.004
Successful DFT%98.7%98.6%98.8%0.97

About the contributors

J Aasbo

Role: Author

J Dinerman

Role: Author

G Mark

Role: Author