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

Background: Separately, electrophysiologic study (EPS) and placement of a transvenous implantable cardioverter‐defibrillator (ICD) can be performed safely in the majority of patients. The safety and potential cost savings of same‐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.