title: Subpectoral implantation of a cardioverter defibrillator under local anaesthesia.
abstract: OBJECTIVE
  To evaluate patient acceptability of submuscular implantation of a cardioverter defibrillator (ICD) under local anaesthesia with conscious sedation.
  
  
  METHODS
  Retrospective review. Patient acceptability in the second half of the study was routinely assessed within 24 hours.
  
  
  METHODS
  Regional cardiac centre.
  
  
  METHODS
  45 consecutive patients with either aborted sudden death or haemodynamically unstable ventricular tachycardia were referred for ICD implantation.
  
  
  METHODS
  A subpectoral implantation technique was employed. Twelve procedures were performed under general anaesthesia. Thirty three patients were sedated with midazolam and diamorphine, and local anaesthesia was achieved with bupivicaine. Ventricular fibrillation for defibrillation threshold testing was induced by alternating current, T wave shock, or ultrarapid burst pacing. Patients were contacted after the procedure to assess acceptability.
  
  
  RESULTS
  32 patients having implantation under local anaesthesia did not recall the surgical procedure. One patient described an awareness of "pushing" as the generator was positioned in the pocket. Seven patients said that the procedure was painless but recalled a test shock, four describing it as mildly uncomfortable. All 33 patients stated that they would be willing to have a second implant under local anaesthesia. Twelve patients who had the implant performed under general anaesthesia had no recollection of the procedure. Mean (SD) total procedure duration was significantly longer in those who had general anaesthesia (93 (16) v 67 (17) minutes; p = 0.0009).
  
  
  CONCLUSIONS
  Subpectoral implantation of ICDs may be performed safely with patient acceptability under local anaesthesia with conscious sedation.
authors.affiliation: University Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Lipscomb
authors.forename: N J
authors.initials: NJ
authors.lastname: Linker
authors.forename: A P
authors.initials: AP
authors.lastname: Fitzpatrick
mesh_terms: D000772:Anesthesia, Local; D016292:Procedural Sedation; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D014693:Ventricular Fibrillation / Q000601:surgery*