Conscious sedation during subcutaneous implantable cardioverter-defibrillator implantation using the intermuscular technique

  • Elif KayaEmail author
  • Rolf Alexander Jánosi
  • Obayda Azizy
  • Reza Wakili
  • Tienush Rassaf



The subcutaneous implantable cardioverter-defibrillator (S-ICD) system is an established therapy for the prevention of sudden cardiac death (SCD) and an alternative to a transvenous implantable cardioverter-defibrillator (ICD) system in selected patients. S-ICDs are usually implanted under general anesthesia. The purpose of the present study was to describe the technical feasibility and safety of local anesthesia with conscious sedation as an alternative to general anesthesia during S-ICD implantation using the intermuscular technique.


We conducted a retrospective, single-center study on patients undergoing S-ICD implantation using the intermuscular technique at our center between February 2016 and May 2018. All procedures were performed under controlled sedation with propofol and midazolam. Local anesthesia was used for all procedures.


Twenty-two patients (17 men and 5 women) with a mean age of 51.1 ± 16.2 years were included. The indication for S-ICD implantation was primary prevention in 18 (81.8%) patients. The mean dose of midazolam and propofol administered was 7.8 ± 2.3 mg and 72.7 ± 37.4 mg, respectively. The procedural success rate was 100%, with no apneic or hypoxic episodes or other complications requiring therapeutic intervention. None of the patients required conversion to general anesthesia. All patients were comfortable with the position and appearance of the device.


Our findings suggest that local anesthesia with conscious sedation using propofol and midazolam is a safe and feasible option for S-ICD implantation procedures using an intermuscular technique.


S-ICD Intermuscular technique General anesthesia Safety Sedation Sudden cardiac death 



American Society of Anesthesiologists


Automated screening tool


Cardiac implantable electronic device


Defibrillation threshold


Implantable cardioverter-defibrillator


Idiopathic ventricular fibrillation






Richmond Agitation-Sedation Scale


Sudden cardiac death


Subcutaneous implantable cardioverter-defibrillator


Ventricular fibrillation


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

The study was approved by the ethics committee of the faculty of medicine of the University of Duisburg-Essen (Reference no. 17-7701-BO), Germany.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center EssenUniversity of Duisburg-EssenEssenGermany

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