Anesthetic practice during cardiac implantable electronic device implant procedures: A retrospective, single-center study

Cecilia Veraar; Kamen Dimitrov; Sabine Kappel; Sophie J Wuthe; Clarence J Veraar; Arabella Fischer; Isabella Worf; Mohamed Mouhieddine; Luana Mandroiu; Bernhard Moser; N Patrick Mayr; Cesar Khazen; Edda Tschernko; Michael J Hiesmayr

doi:10.1016/j.ijcha.2023.101312

Anesthetic practice during cardiac implantable electronic device implant procedures: A retrospective, single-center study

Int J Cardiol Heart Vasc. 2023 Nov 24:49:101312. doi: 10.1016/j.ijcha.2023.101312. eCollection 2023 Dec.

Affiliations

¹ Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, 1090 Vienna, Austria.
² Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
³ Center for Medical Statistics, Institute for Medical Data Science, Medical University Vienna, 1090 Vienna, Austria.
⁴ Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria.
⁵ Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
⁶ Institute of Anaesthesiology, German Heart Centre Munich, Faculty of Medicine, Technical University of Munich, Munich, Germany.

Abstract

Objectives: Data on anesthetic proceedings during cardiac implantable electronic device (CIED) implant procedures are scarce and it remains unclear whether anesthetic care is still required in selected patients.

Methods: In this retrospective, single center study we assessed the prevalence of intraoperative anesthetic management comprising anesthetic standby, sedation or general anesthesia as well as anesthetic and procedural complications. We analyzed pre-existing and perioperative risk factors related to procedure-related adverse outcome such as perioperative cardiopulmonary resuscitation (CPR) and 30-day mortality in a uni- and multivariable analysis.

Results: In total, PM and ICD insertion were performed in up to 85% and 58% under anesthetic standby, with an increasing tendency over time.Overall, Cardiopulmonary resuscitation (CPR) was required in 59 patients. Acute heart failure (AHF) was the only independent pre-existing risk factor for CPR and for 30-day mortality. Sedation and general anesthesia had a significantly increased odds ratio for CPR compared to anesthetic standby. The risk for CPR significantly decreased during the study period.

Conclusions: Over the years anesthetic practice during CIED implant procedures shifted from mixed anesthetic proceedings to mainly standby duties. The prevalence of complications and emergency measures is low, however not uncommon. Accordingly, the presence of an anesthesiologist should be further guaranteed when sedatives were titrated and in AHF patients. However, in patients receiving local anesthetic infiltration only, it seems safe to perform CIED implant procedures without anesthetic standby.

Keywords: Anesthetic intervention; Anesthetic standby; Cardiac implantable electronic device; Human resources; Implantable cardioverter defibrillators; Pacemakers.