{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:44:49Z","timestamp":1787730289295,"version":"build-2784847793"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Extravascular Implantable Cardioverter\u2010Defibrillator (EV\u2010ICD) utilizes a substernal lead to provide defibrillation and anti\u2010tachycardia pacing (ATP) while avoiding transvenous complications. General anesthesia (GA) was applied for implantation procedures in the EV\u2010ICD pivotal trial and is currently recommended by the manufacturer. However, GA carries specific risks and consumes significant resources. This study evaluates the feasibility, safety, and procedural efficiency of EV\u2010ICD implantation performed under cardiologist\u2010administered deep sedation with noninvasive ventilation (DS\u2010NIV) compared to standard GA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 24 consecutive patients undergoing EV\u2010ICD implantation in our center. Patients received either GA (\n                      <jats:italic>n<\/jats:italic>\n                      = 14) or DS\u2010NIV (\n                      <jats:italic>n<\/jats:italic>\n                      = 10) using a propofol\u2010ketamine protocol delivered by cardiologists. Analyses focused on peri\u2010procedural feasibility and safety, procedural workflow and anesthesia characteristics, and early device electrical performance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No anesthesia\u2010related complications occurred in either group. The DS\u2010NIV group demonstrated significantly shorter wheels\u2010to\u2010incision times (median: 45\u00a0vs. 70\u00a0min,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.022), whereas the procedural duration did not differ significantly from the GA group. Patients receiving DS\u2010NIV required fewer vasopressors (60%\u00a0vs. 100%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.024) despite higher propofol infusion rates (800\u00a0vs. 350\u00a0mg\/h,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Defibrillation testing success and electrical parameters were comparable. In a median follow\u2010up of 182 days two patients received appropriate EV\u2010ICD therapies and no inappropriate ATP or shocks were delivered.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>EV\u2010ICD implantation under cardiologist\u2010administered DS\u2010NIV appears to be feasible and safe, offering improved workflow efficiency compared to GA. These findings support deep sedation as a practical alternative in experienced centers, potentially expanding access to EV\u2010ICD therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70323","type":"journal-article","created":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T07:46:36Z","timestamp":1781941596000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["First Experience With Extravascular Implantable Cardioverter\u2010Defibrillator Under Deep Sedation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0272-0525","authenticated-orcid":false,"given":"Nibras","family":"Soubh","sequence":"first","affiliation":[{"name":"Department of Cardiology and Pneumology University Medical Center G\u00f6ttingen (UMG)  G\u00f6ttingen Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Lower Saxony University of G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard C.","family":"Danner","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), partner site Lower Saxony University of G\u00f6ttingen  G\u00f6ttingen Germany"},{"name":"Department of Thoracic and Cardiovascular Surgery University Medical Center in G\u00f6ttingen (UMG)  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Krause","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), partner site Lower Saxony University of G\u00f6ttingen  G\u00f6ttingen Germany"},{"name":"Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine University Medical Center in G\u00f6ttingen (UMG)  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias J.","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), partner site Lower Saxony University of G\u00f6ttingen  G\u00f6ttingen Germany"},{"name":"Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine University Medical Center in G\u00f6ttingen (UMG)  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Zabel","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University Medical Center G\u00f6ttingen (UMG)  G\u00f6ttingen Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Lower Saxony University of G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerd","family":"Hasenfu\u00df","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University Medical Center G\u00f6ttingen (UMG)  G\u00f6ttingen Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Lower Saxony University of G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5897-237X","authenticated-orcid":false,"given":"Constanze","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University Medical Center G\u00f6ttingen (UMG)  G\u00f6ttingen Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Lower Saxony University of G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0566-5827","authenticated-orcid":false,"given":"Helge","family":"Haarmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University Medical Center G\u00f6ttingen (UMG)  G\u00f6ttingen Germany"},{"name":"DZHK (German Center for 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