Arrhythmias & electrophysiology
The evolution of Extravascular Cardioverter Defibrillator implantation: feasibility in a purely electrophysiologic setting
Authors' conclusion
EV-ICD implantation can be safely and effectively performed under cardiologist-directed sedation without anesthesiology supervision, achieving a fully electrophysiology-driven workflow.
Study context
- Population
- Patients undergoing extravascular ICD implantation
- Participants
- 115 patients
- Exposure
- Analgosedation or regional block with limited sedation vs general anaesthesia for extravascular implantable cardioverter-defibrillator (EV-ICD) implantation
- General anesthesia (GA)n = 46reference
- ASn = 28
- RBSn = 41
- Outcome
- Successful implantation without conversion to respiratory or circulatory support
Methodological detailstwo European centres, consecutive patients
- Two European centres
- Consecutive patients
Main finding
As reported in the abstract
Successful implantation (overall)
Overall implantation success
97%
112/115
Observational data: associations, not effects.
Secondary outcomes
| Outcome | GA | RBS | Reduction (minutes) | P value |
|---|---|---|---|---|
| Procedure durationRBS vs GA | 27 | P < 0.001 | ||
| Early mobilizationRBS vs GA · RBS ambulating within 3 h vs GA after 6 h | 65% | 97% | P < 0.001 |
Appropriate ICD therapy · median follow-up 20 [10-30] months
- Appropriate ICD therapy
- 13%
- Arrhythmia termination
- 100%
Safety
Procedure-related complications
- Comparable complication rates across groups
Inappropriate therapy · median follow-up 20 [10-30] months
- Inappropriate therapy, predominantly during early learning phase
- 8.9%
Original publication
The evolution of Extravascular Cardioverter Defibrillator implantation: feasibility in a purely electrophysiologic setting. Europace. Published 19 August 2026. doi:10.
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