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Objectives: Elective electrical cardioversion (ECV) is frequently used for supraventricular tachycardia therapy. However, the success rate of this approach varies, and ventricular arrhythmias may develop as a consequence. We aimed to determine whether the timing of pre-ECV potassium serum testing affects patient outcomes. Materials and Methods: This retrospective cohort study analyzed 65 patients who underwent elective ECV in 2023. Patients were divided into two groups (short-interval vs long-interval) based on the median time (in days) between the potassium test and ECV. The primary outcome measure was the incidence of ventricular arrhythmias, whereas the secondary outcome measure was immediate restoration of sinus rhythm. Results: The median time between the potassium test and ECV was 57 (interquartile range 135) days. No ventricular arrhythmias were observed. There was no statistically significant difference in success rates between the two groups (84.8% versus 84.4%; p=0.958; χ2 test). Predetermined risk factors for potassium disturbances did not influence success rates. Conclusion: Our study suggests that the timing of potassium serum testing does not influence the occurrence of ventricular arrhythmias following elective ECV. In addition, the timing of serum potassium testing did not influence the success rate. Therefore, potassium testing shortly before cardioversion may not be necessary.

Introduction: To avoid general anesthesia (GA) and improve postoperative pain management for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation there is a growing interest for alternative methods. We describe the first experience in the Netherlands of S-ICD implantation under Ultrasound-guided Serratus Anterior Plane Block (US-SAPB). Methods: US-SAPB was performed 1 hour before S-ICD implantation. The two-incision technique was used and a pocket beneath the latissimus dorsi muscle was surgically created. Lidocaine was used to provide anesthesia of the skin. Sedation during defibrillation testing (DFT) was induced by intravenous Propofol. Periprocedural pain experience was monitored using the Numerical Rating Scale for Pain (NRS-Pain). The results were compared with a control group of patients undergoing S-ICD implantation under GA. Results: Forty consecutive patients (29 Male/11 Female, median age 59 years (range 34–84 years), median body mass index 26 (range 17–41) underwent S-ICD implantation; Twenty patients under US-SAPB and twenty under GA. Median procedure time was 42 min. (range 28–60 min.) with no differences between both groups. In both groups implantations went successful and defibrillation was accomplished using 65 J. US-SAPB was successful in 19 of the 20 patients and GA was successful in all cases. Median NRS-Pain in the US-SAPB group was 2 (range 2–6) and in the GA group 4 (range 2–6). In the US-SAPB group 5 patients required additional opioids postoperatively compared to 10 patients in the GA group. Conclusions: S-ICD implantation under US-SAPB is feasible, safe and reduces the need for postoperative opioids significantly. S-ICD implantation under US-SAPB seems a good alternative for GA.

Comminuted subcapital humerus fracture as a complication of subcutaneous implantable cardioverter-defibrillator insertion is related to an abducted and externally rotated arm position during the defibrillation threshold test at which the current pathway is through the pectoral muscle. It is advisable to adduct the arm before defibrillation threshold testing. (Level of Difficulty: Beginner.)