General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study.
Author(s): Di Biase L, Conti S, Mohanty P, Bai R, Sanchez J, Walton D, John A, Santangeli P, Elayi CS, Beheiry S, Gallinghouse GJ, Mohanty S, Horton R, Bailey S, Burkhardt JD, Natale A
Affiliation(s): Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas 78705, USA.
Publication date & source: 2011-03, Heart Rhythm., 8(3):368-72. Epub 2010 Nov 2.
Publication type: Comparative Study; Randomized Controlled Trial
BACKGROUND: Radiofrequency catheter ablation of atrial fibrillation can be performed under general anesthesia or conscious sedation at the physician's preference. OBJECTIVE: We randomized a series of consecutive patients with paroxysmal atrial fibrillation (AF) undergoing radiofrequency catheter ablation to either general anesthesia or conscious sedation to assess differences in pulmonary vein (PV) reconnection during redo procedures and impact on success rate. METHODS: A total of 257 consecutive patients with paroxysmal AF undergoing AF ablation were enrolled and randomized to either conscious sedation with fentanyl or midazolam (128 patients, group 1) and general anesthesia (129 patients, group 2). In all patients, a high dosage of isoproterenol up to 30 mug/min was used to disclose PV reconnection or extra PV firings. RESULTS: Baseline clinical characteristics were not significantly different between the 2 groups. At 17 +/- 8 month follow-up after the first ablation, 88 (69%) patients in group 1 were free of atrial arrhythmias off all antiarrhythmic drugs (AAD), as compared with 114 (88%) in group 2 (log-rank P <.001). All patients with recurrence had a second procedure. At the repeat procedure, 42% (66 of 158) of PVs in group 1 had recovered PV conduction, compared with 19% (11 of 57) in group 2 (P = .003). Compared with group 1, group 2 had a significantly shorter fluoroscopy time (53 +/- 9 min vs. 84 +/- 21 min, P <.001) and procedure time (2.4 +/- 1.4 h vs. 3.6 +/- 1.1 h, P <.001). CONCLUSION: The use of general anesthesia is associated with higher cure rate with a single procedure, and it seems to reduce the prevalence of PV reconnection observed at the time of repeat ablation. Copyright (c) 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.