Takanori Yamaguchi1, Yusuke Shimakawa2, Shinji Mitsumizo3, Akira Fukui4, Yuki Kawano5, Toyokazu Otsubo4, Yuya Takahashi4, Kei Hirota4, Takeshi Tsuchiya4, Kenichi Eshima5. 1. Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan. Electronic address: takano-yamaguchi@nifty.com. 2. Department of Anesthesiology, Saga-ken Medical Centre Koseikan, Saga, Japan. 3. Department of Intensive Care Unit, Saga-ken Medical Centre Koseikan, Saga, Japan. 4. EP Expert Doctors-Team Tsuchiya, Kumamoto, Japan. 5. Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan.
Abstract
BACKGROUND: The optimal methodology for sedation and anesthesia during atrial fibrillation (AF) ablation has not been well established. We assessed the feasibility of total intravenous anesthesia (TIVA) by cardiologists with support from anesthesiologists during AF ablation and quality of pulmonary vein isolation (PVI) and single procedure success rate at 12 months. METHODS: TIVA was performed by cardiologists using IV propofol and fentanyl under controlled ventilation via i-gel™ without neuromuscular blocking drugs in 160 consecutive patients (80 nonparoxysmal) with no anticipated difficult airway or other severe diseases. Anesthesiologists were requested to be on standby during the procedure. The incidence of anesthesia-associated complications and ablation-associated complications were assessed. To evaluate the quality of PVI, the prevalence of acute adenosine triphosphate (ATP)-provoked PV reconnections and late PV reconnections among those requiring a redo procedure was analyzed. RESULTS: TIVA was successfully completed in 152 patients (95%). In five (3%), we requested help from anesthesiologists, and in three (2%), TIVA was abandoned. No major anesthesia-associated complications were observed. Ablation-associated complications were observed in seven patients (4%). ATP provocation test was performed in 141 patients, and no acute PV reconnections were observed in 134 (95%). Success rates at 12 months were 85% of patients off antiarrhythmic drugs. Twenty-one of 24 patients with recurrence underwent a redo session, and 18 (86%) had no PV reconnections. CONCLUSIONS: TIVA by cardiologists with support from anesthesiologists during AF ablation may be feasible. The success rate at 12 months was high, and prevalence of acute and late PV reconnection was very low.
BACKGROUND: The optimal methodology for sedation and anesthesia during atrial fibrillation (AF) ablation has not been well established. We assessed the feasibility of total intravenous anesthesia (TIVA) by cardiologists with support from anesthesiologists during AF ablation and quality of pulmonary vein isolation (PVI) and single procedure success rate at 12 months. METHODS:TIVA was performed by cardiologists using IV propofol and fentanyl under controlled ventilation via i-gel™ without neuromuscular blocking drugs in 160 consecutive patients (80 nonparoxysmal) with no anticipated difficult airway or other severe diseases. Anesthesiologists were requested to be on standby during the procedure. The incidence of anesthesia-associated complications and ablation-associated complications were assessed. To evaluate the quality of PVI, the prevalence of acute adenosine triphosphate (ATP)-provoked PV reconnections and late PV reconnections among those requiring a redo procedure was analyzed. RESULTS:TIVA was successfully completed in 152 patients (95%). In five (3%), we requested help from anesthesiologists, and in three (2%), TIVA was abandoned. No major anesthesia-associated complications were observed. Ablation-associated complications were observed in seven patients (4%). ATP provocation test was performed in 141 patients, and no acute PV reconnections were observed in 134 (95%). Success rates at 12 months were 85% of patients off antiarrhythmic drugs. Twenty-one of 24 patients with recurrence underwent a redo session, and 18 (86%) had no PV reconnections. CONCLUSIONS:TIVA by cardiologists with support from anesthesiologists during AF ablation may be feasible. The success rate at 12 months was high, and prevalence of acute and late PV reconnection was very low.
Authors: Miki Yokokawa; Aman Chugh; Anna Dubovoy; Milo Engoren; Krit Jongnarangsin; Rakesh Latchamsetty; Hamid Ghanbari; Mohammed Saeed; Ryan Cunnane; Thomas Crawford; Michael Ghannam; Jackson Liang; Robert Keast; David Karpenko; Frank Bogun; Frank Pelosi; Timur Dubovoy; Mathew Caldwell; Fred Morady; Hakan Oral Journal: J Cardiovasc Electrophysiol Date: 2022-06-11 Impact factor: 2.942