Safety and potential cost savings of same-setting electrophysiologic testing and placement of transvenous implantable cardioverter-defibrillators

Abstract

Background: Separately, electrophysiologic study (EPS) and placement of a transvenous implantable cardioverterdefibrillator (ICD) can be performed safely in the majority of patients. The safety and potential cost savings of stone-setting procedures have not been evaluated. Hypothesis: Electrophysiologic study and placement of transvenous ICDs can be performed safely in the same setting at reduced cost. Methods: In all, 160 (mean age 65 ± 10 years, 75% men) and 41 (mean age 66 ± 11 years, 73% men) consecutive patients who underwent same- versus separate-setting procedures, respectively, were prospectively evaluated. Results: The two groups had similar clinical characteristics and indications for EPS and ICD therapy. Complications occurred in eight patients (5.0%, 95% confidence interval [CI] 2.3-10.3) who had same-setting procedures (one hypotension during ICD testing, one pocket hematoma, two lead dislodgments, two pneumothoraces, one stroke, and one infection) and in two (4.9%, CI 0.60-16.5) who had separate-setting procedures (one pocket hematoma and one infection). There were no procedure-related deaths or long-term ICD-related complications in either group. The mean time from ICD implantation to hospital discharge was similar in the two groups (2.5 ± 2.4 vs. 2.7 ± 2.2 days, p = NS). The combined procedure cost was higher in patients who had separate-setting procedures ($12,403 ± 1,386 vs. $10,242 ± 2,256, p = < 0.001), who incurred an additional hospital cost of $2,121 ± $2,125 for the waiting period (1.7 ± 1.6 days) between EPS and ICD implantation. Conclusions: In patients deemed candidates for ICD therapy based on EPS results, placement of transvenous defibrillators in the same setting as EPS is as safe as separate-setting procedures and, if adopted, could further reduce the cost of providing ICD therapy.