{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:45:47Z","timestamp":1792053947965,"version":"4.4.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Extravascular implantable cardioverter-defibrillator (EV-ICD) is a novel non-transvenous system delivering defibrillation shocks and anti-tachycardia pacing through a substernal lead. Despite proven efficacy, implantation has traditionally required general anaesthesia and cardiothoracic surgical backup, limiting widespread adoption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate feasibility, safety, and workflow efficiency of EV-ICD implantation under cardiologist-directed sedation without anaesthesiology support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Prospective observational study including 115 consecutive patients undergoing EV-ICD implantation across two European centres. Three procedural settings were explored sequentially: general anaesthesia (GA, n = 46), analgosedation without anaesthesiology supervision (AS, n = 28) and regional block with limited sedation (RBS, n = 41). The primary endpoint was successful implantation without conversion to respiratory or circulatory support. Secondary endpoints included procedure duration, procedure-related complications, and device performance at follow-up. Overall implantation success was 97% (112\/115) in a predominantly young population (50 \u00b1 17 years; 70% male). All procedures performed without anaesthesiology supervision were completed without conversion to GA or emergency support, with comparable complication rates across groups. RBS was associated with a 27-minute reduction in procedural duration vs. GA (P &amp;lt; 0.001) and earlier mobilization (97% ambulating within 3\u2005h vs. 65% after 6\u2005h with GA; P &amp;lt; 0.001). Over a median follow-up of 20 [10\u201330] months, appropriate ICD therapy was delivered in 13% of patients with 100% arrhythmia termination. Inappropriate therapy occurred in 8.9%, predominantly during the early learning phase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>EV-ICD implantation can be safely and effectively performed under cardiologist-directed sedation without anaesthesiology supervision, achieving a fully electrophysiology-driven workflow. Procedural simplification substantially reduces resource utilization and may facilitate broader adoption of this technology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag217","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T11:48:31Z","timestamp":1787140111000},"source":"Crossref","is-referenced-by-count":0,"title":["The evolution of extravascular cardioverter defibrillator implantation: feasibility without general anaesthesia"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4590-8584","authenticated-orcid":false,"given":"Mauro","family":"Biffi","sequence":"first","affiliation":[{"name":"IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Massarenti 9, 40138 Bologna 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0028-5222","authenticated-orcid":false,"given":"Antonio Nicol\u00f2","family":"Izzo","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche e Chirurgiche, Istituto di Cardiologia, Universit\u00e0 di Bologna , via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8285-0704","authenticated-orcid":false,"given":"Carmine","family":"Verde","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche e Chirurgiche, Istituto di Cardiologia, Universit\u00e0 di Bologna , via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8452-7405","authenticated-orcid":false,"given":"Alberto","family":"Spadotto","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche e Chirurgiche, 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Ospedaliero-Universitaria di Bologna , Via Massarenti 9, 40138 Bologna ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3823-3809","authenticated-orcid":false,"given":"Igor","family":"Diemberger","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche e Chirurgiche, Istituto di Cardiologia, Universit\u00e0 di Bologna , via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3617-2739","authenticated-orcid":false,"given":"Matteo","family":"Ziacchi","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Massarenti 9, 40138 Bologna ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4591-4220","authenticated-orcid":false,"given":"Lucas V 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