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Publications

Journal Article Ahead of print

PubMed: 42283457 DOI: 10.1093/europace/euag148

Early complications and long-term outcome of patients treated with a Subcutaneous Cardioverter-Defibrillator: temporal trends and clinical implications of the anesthetic strategies adopted at implant.

Europace

Authors: Luca Donisi, Fawzi Kerkouri, Christelle Marquié, Vincent Probst, Vincent Algalarrondo, Alaa Al Amoura, Marc Badoz, Emilie Bastard, Nathalie Behar, Géraldine Bertaux, Francis Bessiere, Pierre Bordachar, Abdeslam Bouzeman, Gilles Cellarier, Jean-Pierre Chabert, Laure Champ-Rigot, Gael Clerici, Antoine Da Costa, Pascal Defaye, Jean-Claude Deharo, Camille Delahaye, Christian Demasles, Romain Eschalier, Laurent Fauchier, Denis Gaty, Hervé Gorka, Cyril Goujeau, Charles Guenancia, Aurélie Guiot, Alexis Hermida, Isabelle Heurtebise, Jérôme Hourdain, Peggy Jacon, Laurence Jesel, François Jourda, Mikael Laredo, Alain Lebon, Christophe Leclercq, Francois Lesaffre, Jean Litalien, Christophe Loose, Vincent Mansourati, Philippe Maury, Alexis Mechulan, Antoine Milhem, Aurélien Miralles, Frédérique Mizon-Gérard, Pierre Mondoly, Ghassan Moubarak, Jean-Luc Pasquié … and 11 other authors

Affiliations

  • Division of Cardiology, European Georges Pompidou Hospital, Paris, France.
  • Université Paris Cité, PARCC, INSERM U970, 75015 Paris, France.
  • Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
  • Univ Brest, Laboratoire ORPHY EA 4324, F-29200 Brest, France.
  • Department of Cardiology, University Hospital of Brest, Brest, France.
  • Department of Cardiology, University Hospital of Lille, Lille, France.
  • Department of Cardiology, University Hospital of Nantes, Nantes, France.
  • Department of Cardiology, Bichat Hospital, Paris, France.
  • Department of Cardiology, Centre Hospitalier de Troyes, France.
  • Department of Cardiology, University Hospital of Besancon, Besancon, France.
  • Department of Cardiology, Polyclinique Les Fleurs, Toulon, France.
  • Department of Cardiology, Hopital Pontchailloux, Rennes, France.
  • Department of Cardiology, CHU Dijon Bourgogne, France.
  • Department of Cardiology, Hospices Civils de Lyon, France.
  • Department of Cardiology, University Hospital of Bordeaux, Bordeaux, France.
  • Department of Cardiology, Hopital privé de Parly 2, France.
  • Department of Cardiology, Hopital d'instruction des armées Sainte-Anne, Toulon, France.
  • Department of Cardiology, CHU de Reims, France.
  • Department of Cardiology, University Hospital of Caen, Caen, France.
  • Department of Cardiology, University Hospital of La Réunion, Saint-Pierre, La Réunion, France.
  • Department of Cardiology, University Hospital of Saint-Etienne, France.
  • Department of Cardiology, University Hospital of Grenoble, Grenoble, France.
  • Department of Cardiology, University Hospital of Marseille - La Timone, Marseille, France.
  • Department of Cardiology, Centre Hospitalier de Roubaix, France.
  • Department of Cardiology, Centre Hospitalier de Bigorre - Tarbes, France.
  • Department of Cardiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
  • Department of Cardiology, University Hospital of Tours, Tours, France.
  • Department of Cardiology, Centre Hospitalier de Carcassonne, France.
  • Department of Cardiology, Centre Hospitalier de Chartres, France.
  • Department of Cardiology, Centre Hospitalier de Saintonge - Saintes, France.
  • Department of Cardiology, Hôpital privé Bois Bernard - Lens, France.
  • Department of Cardiology, CHU Amiens, France.
  • Department of Cardiology, Centre Hospitalier Jacques Cœur, Bourges, France.
  • Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France.
  • Department of Cardiology, Centre Hospitalier d'Auxerre, France.
  • Department of Cardiology, La Pitié-Salpêtrière Hospital, Paris, France.
  • Department of Cardiology, Hôpital privé Saint-Martin - Caen, France.
  • Department of Cardiology, Centre Hospitalier de Périgueux, France.
  • Department of Cardiology, Clinique Saint-Gatien - Tours, France.
  • Department of Cardiology, University Hospital of Toulouse, Toulouse, France.
  • Department of Cardiology, Hôpital privé Clairval - Marseille, France.
  • Department of Cardiology, Centre Hospitalier de La Rochelle, France.
  • Department of Cardiology, Centre Hospitalier de Valence, France.
  • Department of Cardiology, Hôpital privé Le Bois - Lille Metropole, France.
  • Department of Cardiology, Clinique Ambroise Paré - Neuilly-sur-Seine, France.
  • Department of Cardiology, University Hospital of Montpellier, Montpellier, France.

Abstract

BACKGROUND AND AIMS

Subcutaneous implantable cardioverter defibrillator (S-ICD) therapy is well-established therapy for the prevention of sudden cardiac death. Although general anesthesia (GA) was initially advocated for implantation, non-GA has emerged as a feasible alternative in clinical practice. This study evaluated the early and long-term outcomes associated with anesthetic modality during S-ICD implantation procedures.

METHODS

The HONEST study nationwide, single-arm, observational cohort included all patients implanted with an S-ICD (EMBLEM™, Boston Scientific) in France between 2012 and 2019. GA was characterized by controlled unconsciousness with airway management, while non-GA included all alternative techniques.

RESULTS

Among 4,924 patients, 1,041 (21.1%) underwent non-GA. The proportion of non-GA use increased from 2.5% to 26.9% between 2012 and 2019 (p<0.001). Patients implanted with non-GA modality tended to be older (51 ± 14 vs. 50 ± 15 years), had lower left ventricular ejection fraction (41±16 vs. 43±17%), and fewer secondary prevention indications (33 vs. 38%) (all p<0.01). Thirty-day complication rate was 3.4% in the non-GA group (vs 3.7% in the GA group; p=0.85). At follow-up, the incidence of overall complications (4.29 events per 100 person-years for non-GA versus 4.73 for GA; p=0.937), reintervention (1.21 versus 1.62; p=0.963), inappropriate shocks (2.88 versus 2.78; p=0.782), and all-death (2.93 versus 2.56; p=0.938) were similar between groups. Multivariate analysis confirmed that there were no differences across outcomes (all p values>0.1).

CONCLUSION

Anesthesia strategy used for S-ICD implantation was not associated with poorer short- or long-term clinical outcomes, supporting non-general anesthesia as a feasible alternative in appropriately selected patients.

MeSH

Anesthesia, General, Anesthesia, Mortality, Anesthetics, Death, Sudden, Cardiac, Therapeutics, Defibrillators