Outpatient ICD insertions feasible, safe, and make patients "pretty happy"

May 26, 2006

Boston, MA - Patients receiving not only pacemakers but also implantable cardioverter defibrillators (ICDs) can be safely implanted with a device and discharged the same day, according to data from a single tertiary-care center[1].

In their review of four years of arrhythmia-management-device implantations at a major Veterans Affairs hospital, Dr Janet K Han (West Los Angeles VA Medical Center, CA) and colleagues observed a complication rate of about 3.7% among the 241 procedures. Nearly three quarters involved ICDs, and all but five were performed on an outpatient basis. Implantations included first devices as well as upgrades with lead replacements. Patients were observed for at least two hours in an outpatient recovery unit, discharged, and then seen again in two weeks, the group reported here at the Heart Rhythm Society 2006 Scientific Sessions.

Outpatient implantation procedures, prevalence, and associated complication rates

Procedure outcome and complication rate ICD Pacemaker
Same-day discharge (n) 174 62
Hospital admission (n) 2 3
Total (n) 176* 65
Total complication rate (%) 4 3
*includes 44 single-chamber, 80 dual-chamber, and 52 biventricular devices.

Of the two quickly recognized cardiac perforations, both in patients receiving pacemakers, one caused tamponade, according to the group. All the other complications involved ICDs and included three pocket infections and one each of pneumothorax, lead dislodgement, hypoventilation following sedation, and postoperative bleeding.

Although Han and her colleagues didn't explore how much money was saved by nearly always avoiding a night in the hospital, the financial implications of preventing that many overnights are clear. "And it's not just cost savings. It may also prevent morbidity in the patients by [avoiding] nosocomial infections and deconditioning from being in the hospital," Han told heartwire . "It saves a little psychological trauma. Our patients are surprised and pretty happy about being able to have an outpatient procedure, go home, and sleep in their own beds at night."

Coauthor Dr Zenaida Feliciano (West Los Angeles VA Medical Center) reports receiving consulting fees or honoraria from Guidant. Coauthor Dr Malcolm Bersohn (West Los Angeles VA Medical Center) reports receiving consulting fees or honoraria from ELA Medical and research grants from Vitatron, Biotronik, and ELA Medical.


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