{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T21:21:28Z","timestamp":1760908888070,"version":"3.44.0"},"reference-count":28,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[1997,10,30]]},"published-print":{"date-parts":[[1998,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate patient acceptability of submuscular implantation of a cardioverter defibrillator (ICD) under local anaesthesia with conscious sedation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective review. Patient acceptability in the second half of the study was routinely assessed within 24 hours.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Regional cardiac centre.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>45 consecutive patients with either aborted sudden death or haemodynamically unstable ventricular tachycardia were referred for ICD im- plantation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>A subpectoral implantation technique was employed. Twelve procedures were performed under general anaesthesia. Thirty three patients were sedated with midazolam and diamorphine, and local anaesthesia was achieved with bupivicaine. Ventricular fibrillation for defibrillation threshold testing was induced by alternating current, T wave shock, or ultrarapid burst pacing. Patients were contacted after the procedure to assess acceptability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>32 patients having implantation under local anaesthesia did not recall the surgical procedure. One patient described an awareness of \u201cpushing\u201d as the generator was positioned in the pocket. Seven patients said that the procedure was painless but recalled a test shock, four describing it as mildly uncomfortable. All 33 patients stated that they would be willing to have a second implant under local anaesthesia. Twelve patients who had the implant performed under general anaesthesia had no recollection of the procedure. Mean (SD) total procedure duration was significantly longer in those who had general anaesthesia (93 (16) <jats:italic>v<\/jats:italic> 67 (17) minutes; p\u2009=\u20090.0009).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Subpectoral implantation of ICDs may be performed safely with patient acceptability under local anaesthesia with conscious sedation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/hrt.79.3.253","type":"journal-article","created":{"date-parts":[[2014,10,22]],"date-time":"2014-10-22T15:31:45Z","timestamp":1413991905000},"page":"253-255","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Subpectoral implantation of a cardioverter defibrillator under local anaesthesia"],"prefix":"10.1136","volume":"79","author":[{"given":"K J","family":"Lipscomb","sequence":"first","affiliation":[{"name":"University Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N J","family":"Linker","sequence":"additional","affiliation":[{"name":"University Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A P","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"University Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1998,3,1]]},"reference":[{"key":"2025092005372314000_79.3.253.1","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1161\/01.CIR.87.4.1152","article-title":"Implantable transvenous cardioverter defibrillators.","volume":"87","author":"Bardy","year":"1993","journal-title":"Circulation"},{"key":"2025092005372314000_79.3.253.2","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.1161\/01.CIR.89.6.2503","article-title":"Electrophysiological laboratory, electrophysiologist implanted, non-thoracotomy-implantable cardioverter\/defibrillators.","volume":"89","author":"Fitzpatrick","year":"1994","journal-title":"Circulation"},{"key":"2025092005372314000_79.3.253.3","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/S0025-6196(12)62213-7","article-title":"Consistent subcutaneous prepectoral implantation of a new cardioverter 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joint.","volume":"16","author":"Magney","year":"1993","journal-title":"PACE"},{"key":"2025092005372314000_79.3.253.20","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1111\/j.1540-8159.1993.tb01606.x","article-title":"Anatomical and morphological evaluation of pacemaker lead compression.","volume":"16","author":"Jacobs","year":"1993","journal-title":"PACE"},{"key":"2025092005372314000_79.3.253.21","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1055\/s-2007-1005679","article-title":"The role of pethidine in sedation for colonoscopy.","volume":"27","author":"Rembacken","year":"1995","journal-title":"Endoscopy"},{"key":"2025092005372314000_79.3.253.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(95)70073-0"},{"key":"2025092005372314000_79.3.253.23","first-page":"704","article-title":"Acceptability of high colonoscopy using different premedication: a comparison of the effect of midazolam versus midazolam and pethidine from the viewpoint of the patient and the physician.","volume":"33","author":"Ehrle","year":"1995","journal-title":"Gastroenterology (Germany)"},{"key":"2025092005372314000_79.3.253.24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/00006565-199602000-00009","article-title":"Conscious sedation for pediatric orthopaedic emergencies.","volume":"12","author":"Graff","year":"1996","journal-title":"Pediatr Emerg Care"},{"key":"2025092005372314000_79.3.253.25","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)65654-4"},{"key":"2025092005372314000_79.3.253.26","first-page":"57","article-title":"The safety and efficacy of outpatient midazolam intravenous sedation for oral surgery with and without fentanyl.","volume":"40","author":"Milgrom","year":"1993","journal-title":"Anesth Prog"},{"key":"2025092005372314000_79.3.253.27","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/j.1399-6576.1995.tb04377.x","article-title":"Reversal of conscious sedation by flumazenil: current status and future 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