Early complications and long-term outcome of patients treated with a Subcutaneous Cardioverter-Defibrillator: temporal trends and clinical implications of the anesthetic strategies adopted at implant

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ID: 317195
2026
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Abstract
BACKGROUND AND AIMS: Subcutaneous implantable cardioverter defibrillator (S-ICD) therapy is well-established therapy for the prevention of sudden cardiac death. Although general anesthesia (GA) was initially advocated for implantation, non-GA has emerged as a feasible alternative in clinical practice. This study evaluated the early and long-term outcomes associated with anesthetic modality during S-ICD implantation procedures. METHODS: The HONEST study nationwide, single-arm, observational cohort included all patients implanted with an S-ICD (EMBLEM™, Boston Scientific) in France between 2012 and 2019. GA was characterized by controlled unconsciousness with airway management, while non-GA included all alternative techniques. RESULTS: Among 4,924 patients, 1,041 (21.1%) underwent non-GA. The proportion of non-GA use increased from 2.5% to 26.9% between 2012 and 2019 (p<0.001). Patients implanted with non-GA modality tended to be older (51 ± 14 vs. 50 ± 15 years), had lower left ventricular ejection fraction (41±16 vs. 43±17%), and fewer secondary prevention indications (33 vs. 38%) (all p<0.01). Thirty-day complication rate was 3.4% in the non-GA group (vs 3.7% in the GA group; p=0.85). At follow-up, the incidence of overall complications (4.29 events per 100 person-years for non-GA versus 4.73 for GA; p=0.937), reintervention (1.21 versus 1.62; p=0.963), inappropriate shocks (2.88 versus 2.78; p=0.782), and all-death (2.93 versus 2.56; p=0.938) were similar between groups. Multivariate analysis confirmed that there were no differences across outcomes (all p values>0.1). CONCLUSION: Anesthesia strategy used for S-ICD implantation was not associated with poorer short- or long-term clinical outcomes, supporting non-general anesthesia as a feasible alternative in appropriately selected patients.
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Authors L. Donisi, Fawzi Kerkouri, Morin Christelle, Vincent Probst, Vincent Algalarrondo, Alaa Al Amoura, Marc Badoz, Emilie Bastard, Nathalie Béhar, Géraldine Bertaux, Francis Bessière, Pierre Bordachar, Abdeslam Bouzeman, Gilles Cellarier, Jean-Pierre Chabert, Laure Champ‐Rigot, Gaël Clerici, Antoine Da Costa, Pascal Defaye, Jean‐Claude Deharo, Camille Delahaye, Christian Demasles, Romain Eschalier, Laurent Fauchier, Denis Gaty, Hervé Gorka, Cyril Goujeau, Charles Guenancia, Aurélie Guiot, Alexis Hermida, Isabelle Heurtebise, Jérôme Hourdain, Peggy Jacon, Laurence Jesel, François Jourda, Mikaël Laredo, Alain Lebon, Christophe Leclercq, François Lesaffre, Jean Litalien, Christophe Loose, Vincent Mansourati, Philippe Maury, Alexis Mechulan, Antoine Milhem, Aurélien Miralles, Frédérique Mizon-Gérard, Pierre Mondoly, Ghassan Moubarak, Jean‐Luc Pasquié, D Perrot, Mickael Peyrol, A Quentin, Nicolas Sadoul, Marc Strik, Claire Vannesson, Frédéric Victor, Aude Zanutto, Serge Bovéda, Éloi Marijon, Rodrigue Garcia
Journal EP Europace
Year 2026
DOI
10.1093/europace/euag148
URL
https://doi.org/10.1093/europace/euag148
Keywords Keywords not found

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