TY - JOUR T1 - First Experience With Extravascular Implantable Cardioverter-Defibrillator Under Deep Sedation. AU - Soubh,Nibras, AU - Danner,Bernhard C, AU - Krause,Ulrich, AU - Müller,Matthias J, AU - Zabel,Markus, AU - Hasenfuβ,Gerd, AU - Schmidt,Constanze, AU - Haarmann,Helge, AU - Rasenack,Eva, AU - Bergau,Leonard, Y1 - 2026/06/20/ PY - 2026/05/18/revised PY - 2026/04/24/received PY - 2026/05/25/accepted PY - 2026/6/20/medline PY - 2026/6/20/pubmed PY - 2026/6/20/entrez KW - Deep sedation KW - EV‐ICD KW - Extravascular ICD KW - General anesthesia KW - Noninvasive ventilation KW - Substernal lead JF - Pacing and clinical electrophysiology : PACE JO - Pacing Clin Electrophysiol N2 - BACKGROUND: The Extravascular Implantable Cardioverter-Defibrillator (EV-ICD) utilizes a substernal lead to provide defibrillation and anti-tachycardia pacing (ATP) while avoiding transvenous complications. General anesthesia (GA) was applied for implantation procedures in the EV-ICD 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-ICD implantation performed under cardiologist-administered deep sedation with noninvasive ventilation (DS-NIV) compared to standard GA. METHODS: We retrospectively analyzed 24 consecutive patients undergoing EV-ICD implantation in our center. Patients received either GA (n = 14) or DS-NIV (n = 10) using a propofol-ketamine protocol delivered by cardiologists. Analyses focused on peri-procedural feasibility and safety, procedural workflow and anesthesia characteristics, and early device electrical performance. RESULTS: No anesthesia-related complications occurred in either group. The DS-NIV group demonstrated significantly shorter wheels-to-incision times (median: 45 vs. 70 min, p = 0.022), whereas the procedural duration did not differ significantly from the GA group. Patients receiving DS-NIV required fewer vasopressors (60% vs. 100%, p = 0.024) despite higher propofol infusion rates (800 vs. 350 mg/h, P<0.001). Defibrillation testing success and electrical parameters were comparable. In a median follow-up of 182 days two patients received appropriate EV-ICD therapies and no inappropriate ATP or shocks were delivered. CONCLUSION: EV-ICD implantation under cardiologist-administered DS-NIV 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-ICD therapy. SN - 1540-8159 UR - https://www.unboundmedicine.com/prime/citation/42322111/First_Experience_With_Extravascular_Implantable_Cardioverter-Defibrillator_Under_Deep_Sedation. DB - PRIME DP - Unbound Medicine ER -