Abstract
Purpose
Operative anaesthetic requirements and perioperative discomfort are barriers to wide adoption of the subcutaneous implantable cardioverter defibrillator (S-ICD) system, especially when the intermuscular technique is used because of the greater amount of tissue dissection. The procedure is most commonly performed under general anaesthesia (GA). There is growing interest in transitioning away from the routine use of GA and towards several alternative anaesthesia modalities for the S-ICD implant procedure without the involvement of an anaesthesiologist. We assessed the feasibility of ultrasound-guided serratus anterior plane block (US-SAPB) in patients undergoing S-ICD implantation with the intermuscular two-incision technique.
Methods
The study population included 38 consecutive patients (84% male; median, 53 [46–62] years) who received S-ICD implantation using the intermuscular two-incision technique. All procedures were performed under US-SAPB and conscious sedation without the involvement of an anaesthesiologist.
Results
The average procedure time was 67 ± 14 min. No patient experienced significant haemodynamic changes or oxygen desaturation during the period of the US-SAPB procedure and sedation; there was no need for pharmacological interventions. The entire procedure was well tolerated without discomfort or complications and with no need for GA, except in one (2.6%) patient who received GA with a laryngeal mask airway. Patients always remained able to respond appropriately to neurological monitoring during the S-ICD implantation procedure. There were no procedure-related complications.
Conclusions
US-SAPB and the intermuscular two-incision technique may be a promising safe and feasible combination for S-ICD implantation, overcoming the potential barrier to wider S-ICD adoption in clinical practice.
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References
Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2018;2017:e190–252.
Boersma L, Barr C, Knops R, et al. EFFORTLESS Investigator Group. Implant and midterm outcomes of the subcutaneous implantable cardioverter-defibrillator registry the EFFORTLESS study. J Am Coll Cardiol. 2017;70:830–41.
Gold MR, Aasbo JD, El-Chami MF, et al. Post-approval study: clinical characteristics and perioperative results. Heart Rhythm. 2017;14:1456–63.
Migliore F, Allocca G, Calzolari V, et al. Intermuscular two-incision technique for subcutaneous implantable cardioverter defibrillator implantation: results from a multicenter registry. Pacing Clin Electrophysiol. 2017;40:278–85.
Migliore F, Mattesi G, De Franceschi P, et al. Multicentre experience with the second-generation subcutaneous implantable cardioverter defibrillator and the intermuscular two-incision implantation technique. J Cardiovasc Electrophysiol. 2019;30:854–64.
Winter J, Siekiera M, Shin DI, et al. Intermuscular technique for implantation of the subcutaneous implantable cardioverter defibrillator: long-term performance and complications. Europace. 2017;19:2036–41.
Essandoh MK, Mark GE, Aasbo JD, et al. Anesthesia for subcutaneous implantable cardioverter-defibrillator implantation: perspectives from the clinical experience of a US panel of physicians. Pacing Clin Electrophysiol. 2018;41:807–16.
Essandoh MK, Otey AJ, Abdel-Rasoul M, et al. Monitored anesthesia care for subcutaneous cardioverter-defibrillator implantation: a single-center experience. J Cardiothorac Vasc Anesth. 2016;30:1228–33.
Peyrol M, Barraud J, Cautela J, et al. Controlled sedation with midazolam and analgesis with nalbuphine to alleviate pain in patients undergoing subcutaneous implantable cardioverter defibrillator implantation. J Interv Card Electrophysiol. 2017;49:191–6.
Miller MA, Bhatt HV, Weiner M, et al. Implantation of the subcutaneous implantable cardioverter-defibrillator with truncal plane blocks. Heart Rhythm. 2018;15:1108–11.
Kaya E, Jánosi RA, Azizy O, Wakili R, Rassaf T. Conscious sedation during subcutaneous implantable cardioverter-defibrillator implantation using the intermuscular technique. J Interv Card Electrophysiol. 2019;54:59–64.
Miller MA, Garg J, Salter B, et al. Feasibility of subcutaneous implantable cardioverter-defibrillator implantation with opioid sparing truncal plane blocks and deep sedation. J Cardiovasc Electrophysiol. 2019;30:141–8.
Droghetti A, Basso Ricci E, Scimia P, Harizai F, Marini M. Ultrasound-guided serratus anterior plane block combined with the two-incision technique for subcutaneous ICD implantation. Pacing Clin Electrophysiol. 2018;41:517–23.
Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaes- thesia. 2013;68:1107–13.
Braver O, Semyonov M, Reina Y, Konstantino Y, Haim M, Winter J. Novel strategy of subcutaneous implantable cardioverter defibrillator implantation under regional anesthesia. J Cardiothorac Vasc Anesth. 2019;33:2513–6.
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Migliore, F., De Franceschi, P., De Lazzari, M. et al. Ultrasound-guided serratus anterior plane block for subcutaneous implantable cardioverter defibrillator implantation using the intermuscular two-incision technique. J Interv Card Electrophysiol 57, 303–309 (2020). https://doi.org/10.1007/s10840-019-00669-x
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DOI: https://doi.org/10.1007/s10840-019-00669-x