General Anesthesia Versus Sedation for Implantation of a Biventricular Pacing Device for Cardiac Resynchronization Therapy

Feasibility and safety of using local anaesthesia with conscious sedation during complex cardiac implantable electronic device procedures

“…In our consecutive cohort, no deaths or circumstances necessitating intubation or formal ventilatory support associated with the use of local anaesthesia and conscious sedation were observed. The safety and convenience of device implantation that we noted using our approach are consistent with those found in some previous reports 2 – 4 , 6 – 8 , 11 . A large single-centre study found that intravenous sedation could be safely administered in the absence of an anaesthesiologist 9 .…”

“…Sedation with midazolam is usually operator-guided and has been demonstrated as safe and effective for several different procedures 3 . In recent years, this approach has been similarly implemented for pacemaker implantation 8 . However, there is some hesitation regarding the use of local anaesthesia with conscious sedation for complex CRT device implantation procedures or s-ICD implantation procedures requiring subcutaneous leads.…”

Impact of intraoperative mechanical ventilation on left ventricular lead function in cardiac resynchronization therapy

“…Despite these findings, no or spare data concerning the effect of the intraoperative ventilation strategy or the BMI on postoperative LV lead function is available. Theron et al . demonstrated that there was no difference between a CMV and “sedation only” group with regard to safety endpoints such as 30‐day mortality, unplanned intensive care admission, or length of intrahospital stay.…”

“…demonstrated that there was no difference between a CMV and “sedation only” group with regard to safety endpoints such as 30‐day mortality, unplanned intensive care admission, or length of intrahospital stay. Thus, both strategies seem to be safe and can be implemented in critically ill patients undergoing CRT implantation . However, drug‐induced paralysis and mechanical ventilation may create a different setting during operative LV lead placement compared to patients with spontaneous breathing.…”

“…These effects reverse during subsequent spontaneous breathing (SB) and therefore may influence postoperative LV lead position/function. Currently, both “sedation only” allowing for SB and general anesthesia rendering CMV have been proven to be safe and effective and are incorporated in the daily routine during CRT implantation. However, the impact of a SB or CMV strategy on postoperative LV lead function in normal weighted or rather obese patients remains unclear.…”