title: Comparison of three different automatic defibrillator implantation approaches: pectoral implantation using conscious sedation reduces procedure times and cost.
abstract: Recent technological advances in implantable defibrillator systems (ICD) have changed implantation approaches. The aim of this study was to investigate the influence of these improvements on procedure times, implant-related charges, patient recovery, and morbidity. Ninety-six consecutive patients undergoing implantation of a nonthoracotomy ICD were studied. Implantation was performed under general anesthesia with the generator placed abdominally in 22 patients (group I) and pectorally in 40 patients (group II). Thirty-four patients underwent pectoral implantation using conscious sedation (group III). Groups were comparable with respect to clinical variables. Implantation duration and total procedure duration were shorter in group III (67 +/- 21 minutes and 117 +/- 30 minutes) when compared with group I (100 +/- 25 minutes and 157 +/- 39 minutes) and group II (86 +/- 24 minutes and 153 +/- 34 minutes, P < 0.05). Patients in group III did not require admission to the Post-Anesthesia Care Unit. In contrast, patients in groups I and II spent 92 +/- 28 minutes and 91 +/- 31 minutes in the Post-Anesthesia Care Unit. Implantation-related charges were reduced in patients having pectoral implantation using conscious sedation ($1451 +/- 217 vs. $2354 +/- 550 and $2796 +/- 384, P < 0.05). Patients in group III had a lower frequency of postoperative oral analgesic use (3.2 +/- 2.7 doses, P < 0.05) and a shortened post-operative length of stay (1.9 +/- 1.6 days, P < 0.05) when compared with groups I (5.7 +/- 4.0 doses and 3.3 +/- 1.4 days) and II (5.2 +/- 3.5 doses and 2.6 +/- 1.1 days). The overall complication rate was low (6.3%), with no differences between groups. Advances in ICD technology have simplified implantation, leading to shorter, less painful, and less expensive procedures.
authors.affiliation: Section of Cardiac Electrophysiology, Emory University Hospital, Atlanta, Georgia 30322, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bollmann
authors.forename: N K
authors.initials: NK
authors.lastname: Kanuru
authors.forename: D
authors.initials: D
authors.lastname: DeLurgio
authors.forename: P F
authors.initials: PF
authors.lastname: Walter
authors.forename: J C
authors.initials: JC
authors.lastname: Burnette
authors.forename: J J
authors.initials: JJ
authors.lastname: Langberg
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D016292:Procedural Sedation; D017147:Defibrillators, Implantable; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011182:Postoperative Care; D019616:Thoracic Surgical Procedures / Q000191:economics; D013997:Time Factors