16. ICD: Defibrillation Threshold Testing & Other Issues

The aim of this study was to evaluate efficacy and safety of propofol (P) direct administration by the physician performing ICD implant (ICDI) or transthoracic electrical cardioversion (TEC) without an anaesthesiologist attending the procedure. Before starting this evaluation, a pilot experience was made since September 2004 to December 2004. During this phase, 25 patients underwent ICDI (18 patients) or TEC (7 patients) with an anestesiological assistance, in order to teach electrophysiologist team use of P and possible adverse effect. After this preliminary phase, the study was begun. Since January 2005, 31 pts (23 male, mean age 59 ± 13 yrs, range 25 – 80 yrs) underwent ICDI with defibrillation threshold evaluation (20 pts) or TEC (11 pts). Sedation induction was obtained with propofol. The drug was administered starting with a 40 mg injection and increasing the dose until sedation was obtained. Mean dose administered was of 64 ± 19 mg, with a mean weight adjusted dose of 0.84 ± 0.21 mg/kg. In heavier patients (considering patients whose weight was higher than median weight value of 78 kg) we observed a lower weight adjusted P dose (0.79 ± 0.21 mg/kg vs 0.89 ± 0.21 mg/kg) even if the difference didn't reach statistical significance. No adverse effects were observed during the study phase. In conclusion, after adequate training period, P use during electrophysiological procedures without direct anaesthesiologist attendance in the surgical room seems to be efficacious and safe.