Early complications and long-term outcomes of patients treated with a subcutaneous cardioverter-defibrillator: temporal trends and clinical implications of the anaesthetic strategies adopted at implant.

AIMS: Subcutaneous implantable cardioverter defibrillator (S-ICD) therapy is a well-established therapy for the prevention of sudden cardiac death. Although general anaesthesia (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 anaesthetic modality during S-ICD implantation procedures.

METHODS AND

RESULTS

The nationwide, single-arm, observational HONEST cohort study included all patients implanted with an S-ICD (EMBLEM™, Boston Scientific) in France between 2012 and 2019. GA was characterised by controlled unconsciousness with airway management, while non-GA included all alternative techniques. Among 4924 patients, 1041 (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 undergoing implantation under non-GA 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). The 30-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 vs. 4.73 for GA; P = 0.937), reintervention (1.21 vs. 1.62; P = 0.963), inappropriate shocks (2.88 vs. 2.78; P = 0.782), and all-cause mortality (2.93 vs. 2.56; P = 0.938) were similar between groups. Multivariable analysis confirmed that there were no differences across outcomes (all P values >0.1).

CONCLUSION

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

CLINICALTRIALS.GOV ID: NCT05302115.