Implantation of subcutaneous defibrillator is feasible and safe with monitored anesthesia care.

BACKGROUND: The perioperative anesthesia care during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is still evolving. OBJECTIVE: To assess the feasibility and safety of S-ICD implantation with monitored anesthesia care (MAC) versus general anesthesia (GA) in a tertiary care center. METHODS: This is a single-center retrospective study of patients undergoing S-ICD implantation between October 2012 and May 2019. Patients were categorized into MAC and GA group based on the mode of anesthesia. Procedural success without escalation to GA was the primary endpoint of the study, whereas intraprocedural hemodynamics, need of pharmacological support for hypotension and bradycardia, length of the procedure, stay in the post-anesthesia care unit, and postoperative pain were assessed as secondary endpoints. RESULTS: The study comprises 287 patients with MAC in 111 and GA in 176 patients. Compared to MAC, patients in GA group were younger and had a higher body mass index. All patients had successful S-ICD implantation. Only one patient (0.9%) in the MAC group was converted to GA. Despite a similar baseline heart rate (HR) and mean arterial blood pressure (MAP) in both groups, patients with GA had significantly lower HR and MAP during the procedure and more frequently required pharmacological hemodynamic support. Length of the procedure, stay in the postanesthesia care unit, and postoperative pain was similar in both groups. CONCLUSION: This retrospective experience suggests that implantation of S-ICD is feasible and safe with MAC. Use of GA is associated with more frequent administration of hemodynamic drugs during S-ICD implantation.

Identification of Repetitive Activation Patterns Using Novel Computational Analysis of Multielectrode Recordings During Atrial Fibrillation and Flutter in Humans.

OBJECTIVES: The purpose of this study was to assess computational analysis of 64-electrode basket catheter (BC) recordings of atrial fibrillation (AF) and atrial flutter using novel software, CARTOFINDER (CF). BACKGROUND: Repetitive patterns have been recorded during AF and reported to be an important mechanism of AF. CF was used to identify rotational repetitive activation patterns (RAPs) in the right (RA) and left atrium (LA). METHODS: To assess for presence of RAPs, multiple 1-min BC maps of the RA and LA were obtained before and after radiofrequency ablation (RFA) around the pulmonary veins in 14 patients undergoing AF ablation. Validation of the CF algorithm was based on analysis of BC recordings of the cavotricuspid isthmus flutter. RESULTS: There were 2.9 rotational RAPs per patient (1.3 RA; 1.6 LA). No RAPs were noted in 2 patients. RFA was delivered on top of (n = 10), within 5 mm (n = 5), or distant (n = 10) from any RAP. Reproducibility of the BC to identify the same RAP was 82%. Post-pulmonary vein (PV) isolation, there was a 45% reduction in RAP versus pre-RFA. CF was validated by 4 electrophysiologists blindly reviewing 32 RA CF maps. Electrophysiologists correctly categorized presence/absence of RAP in 122 of 128 maps (95%). CONCLUSIONS: CF is novel software incorporated into CARTO that identifies rotational RAP in the RA and LA with 82% reproducibility. PV RFA results in 45% reduction of RAP, suggesting that RFA beyond PV isolation is required to eliminate the bulk of RAP. Electrophysiologists who were first-time users of CF could readily identify RAPs.