Chaired by Devi Nair (Jonesboro, US), this session featured Andrea Droghetti (Turin, IT) as the case operator, alongside a panel including Laura Perrotta (Florence, IT), Daniel Stevens (Cologne, DE), and Julia Vogler (Lübeck, DE). Dr Droghetti detailed best practices for subcutaneous implantable cardioverter-defibrillator (SICD) implantation, focusing on anaesthesia management and surgical technique. He emphasised transitioning from general anaesthesia to regional anaesthesia techniques, such as serratus anterior plane blocks and parasternal blocks, which allow awake procedures and improved post-operative pain control. Using ultrasound-guided blocks, he demonstrated their effectiveness and safety, highlighting their benefit in high-risk patients.

The discussion also covered surgical refinements, including optimal incision placement, tunnelling techniques and intermuscular pocket creation to minimise complications. Dr Droghetti underscored the importance of proper anatomical landmarking, tissue handling and lead fixation, to ensure device longevity and reduce migration risks. The panel debated the learning curve and feasibility of incorporating regional blocks into electrophysiology practice, with particular attention to patient selection, procedural efficiency and post-operative pain management.

The session concluded with insights into SICD’s growing role in younger patients and those at risk of lead-related complications, as well as future possibilities integrating SICD with leadless pacing for ATP delivery.