Document Detail


General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study.
MedLine Citation:
PMID:  21055479     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 μg/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.
Authors:
Luigi Di Biase; Sergio Conti; Prasant Mohanty; Rong Bai; Javier Sanchez; David Walton; Annie John; Pasquale Santangeli; Claude S Elayi; Salwa Beheiry; G Joseph Gallinghouse; Sanghamitra Mohanty; Rodney Horton; Shane Bailey; J David Burkhardt; Andrea Natale
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2010-11-02
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  8     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-01     Completed Date:  2011-07-28     Revised Date:  2011-09-08    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  368-72     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Affiliation:
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas 78705, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anesthesia, General
Atrial Fibrillation / surgery*
Conscious Sedation
Female
Fluoroscopy
High-Frequency Jet Ventilation
Humans
Male
Middle Aged
Pulmonary Veins / surgery*
Reoperation
Comments/Corrections
Comment In:
Heart Rhythm. 2011 Aug;8(8):e1; author reply e1-2   [PMID:  21699865 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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