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
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.
Related
- Maternal gut microbiota, tryptophan metabolism and immune homeostasis: Implications for the prevention of adverse pregnancy complications
- The anti-dyskinetic and the anti-parkinsonian effects of sub-anesthetic ketamine are also present in female preclinical models
- Ultrasonic local anesthetic uncaging enables noninvasive, targeted, and transient knock-out of brain function
- Dyskinesia induced by a dopamine 2 receptor-like agonist, but not a dopamine 1 receptor-like agonist, is blocked by sub-anesthetic ketamine
- Neuroprotective activity of sub-anesthetic ketamine in a preclinical model of Parkinson's disease is not blocked by antagonizing brain-derived neurotrophic factor signaling
BibTeX
@article{donisi2026early,
title = {{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}},
author = {Luca Donisi and Fawzi Kerkouri and Christelle Marquié and Vincent Probst and Vincent Algalarrondo and Alaa Al Amoura and Marc Badoz and Emilie Bastard and Nathalie Behar and Géraldine Bertaux and Francis Bessiere and Pierre Bordachar and Abdeslam Bouzeman and Gilles Cellarier and Jean-Pierre Chabert and Laure Champ-Rigot and Gael Clerici and Antoine da Costa and Pascal Defaye and Jean-Claude Deharo and Camille Delahaye and Christian Demasles and Romain Eschalier and Laurent Fauchier and Denis Gaty and Hervé Gorka and Cyril Goujeau and Charles Guenancia and Aurélie Guiot and Alexis Hermida and Isabelle Heurtebise and Jérôme Hourdain and Peggy Jacon and Laurence Jesel and François Jourda and Mikael Laredo and Alain Lebon and Christophe Leclercq and Francois Lesaffre and Jean Litalien and Christophe Loose and Vincent Mansourati and Philippe Maury and Alexis Mechulan and Antoine Milhem and Aurélien Miralles and Frédérique Mizon-Gérard and Pierre Mondoly and Ghassan Moubarak and Jean-Luc Pasquié and David Perrot and Mickaël Peyrol and Anne Quentin and Nicolas Sadoul and Marc Strik and Claire Vannesson and Frédéric Victor and Aude Zanutto and Serge Boveda and Eloi Marijon},
journal = {EP-Europace},
year = {2026},
month = jun,
doi = {10.1093/europace/euag148},
url = {https://u-picardie.hal.science/hal-05662309v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Luca Donisi
AU - Fawzi Kerkouri
AU - Christelle Marquié
AU - Vincent Probst
AU - Vincent Algalarrondo
AU - Alaa Al Amoura
AU - Marc Badoz
AU - Emilie Bastard
AU - Nathalie Behar
AU - Géraldine Bertaux
AU - Francis Bessiere
AU - Pierre Bordachar
AU - Abdeslam Bouzeman
AU - Gilles Cellarier
AU - Jean-Pierre Chabert
AU - Laure Champ-Rigot
AU - Gael Clerici
AU - Antoine da Costa
AU - Pascal Defaye
AU - Jean-Claude Deharo
AU - Camille Delahaye
AU - Christian Demasles
AU - Romain Eschalier
AU - Laurent Fauchier
AU - Denis Gaty
AU - Hervé Gorka
AU - Cyril Goujeau
AU - Charles Guenancia
AU - Aurélie Guiot
AU - Alexis Hermida
AU - Isabelle Heurtebise
AU - Jérôme Hourdain
AU - Peggy Jacon
AU - Laurence Jesel
AU - François Jourda
AU - Mikael Laredo
AU - Alain Lebon
AU - Christophe Leclercq
AU - Francois Lesaffre
AU - Jean Litalien
AU - Christophe Loose
AU - Vincent Mansourati
AU - Philippe Maury
AU - Alexis Mechulan
AU - Antoine Milhem
AU - Aurélien Miralles
AU - Frédérique Mizon-Gérard
AU - Pierre Mondoly
AU - Ghassan Moubarak
AU - Jean-Luc Pasquié
AU - David Perrot
AU - Mickaël Peyrol
AU - Anne Quentin
AU - Nicolas Sadoul
AU - Marc Strik
AU - Claire Vannesson
AU - Frédéric Victor
AU - Aude Zanutto
AU - Serge Boveda
AU - Eloi Marijon
PY - 2026
DA - 2026/06/12
JO - EP-Europace
DO - 10.1093/europace/euag148
UR - https://u-picardie.hal.science/hal-05662309v1
AB - 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.
SN - 1099-5129
SN - 1532-2092
ER -