General anesthesia improves contact force and reduces gap formation in pulmonary vein isolation: a comparison with conscious sedation

Abstract

Compared to conscious sedation (CS), the use of general anesthesia (GA) in pulmonary vein isolation (PVI) is associated with a lower recurrence rate of atrial fibrillation (AF). GA may improve catheter stability and mapping system accuracy compared to CS, but its influence on contact force (CF) parameters during ipsilateral PVI has not previously been investigated. The study population comprised 176 consecutive patients (107 in GA group and 69 in CS group) with AF who underwent their first PVI procedure. We retrospectively assessed CF parameters, force-time integral (FTI), FTI/wall thickness during anatomical ipsilateral PVI and long-term outcome after ablation. Complete PVI with single continuous circular lesions around the ipsilateral PVs was achieved in 54 patients (50.5%) in the GA group but only 24 patients (34.8%) in the CS group (P = 0.04). The distribution of gaps did not differ between the groups. All CF parameters were significantly higher in the GA group than in the CS group (average CF: 19.4 ± 8.7 vs. 16.7 ± 7.7 g, P < 0.0001; FTI: 399.0 ± 262.5 vs. 293.9 ± 193.4 gs, P < 0.0001; FTI/wall thickness: 155.5 ± 106.1 vs. 115.7 ± 85.5 gs, P < 0.0001). GA was associated with lower AF recurrence rate in patients with paroxysmal AF but not with persistent AF. Compared with CS, GA improves CF parameters, FTI and FTI/wall thickness, and reduced gap formation after ipsilateral PVI.

General anesthesia during atrial fibrillation ablation: Standardized protocol and experience

“…There was a lower number of PV reconnections found for those patients that underwent redo procedures in the GA group. Other studies have also shown that GA can lead to more stable catheter manipulation and better contact force and reduction of gaps 5 . The positive impact of GA on persistent AF ablation outcomes has been documented as well 6 …”

“…Therefore, there is value in understanding and standardizing GA protocols with special consideration on the specific needs of EP procedures. Interestingly, the choice of anesthesia during AF ablation has been shown to affect long‐term outcomes 4‐6 . Hence, as we strive to standardize AF ablation procedures, special consideration should be given to the sedation or anesthesia protocol used.…”

“…Patients are also less likely to move and distort the created geometry during GA, which is particularly important as electrophysiologists rely more heavily on the electro‐anatomic mapping (EAM) systems for catheter navigation. Control of the respiratory cycle also allows for better gating of the EAM system and improves catheter stability with improved contact force 5 . Finally, GA has been shown to improve outcomes after ablation of AF 6,7 …”

General anesthesia or conscious sedation in paroxysmal atrial fibrillation catheter ablation

“…Using catheters with contact-force, Chikata et al demonstrated that RFA in GA improves the contact force and thus increases the rate of PVI made by just one encircling lesion (first pass PVI) (50.5% vs. 34.8%, P=0.04) (ref. 4 ).…”

Impact of left atrial size on isolation area in the acute phase of pulmonary vein isolation using 28 mm cryoballoon

“…RF catheter ablation was performed under general anesthesia or conscious sedation. The detailed procedure for anatomical ipsilateral PVI using an RF catheter has been previously described . In brief, an ablation catheter was used, and extensive encircling of ipsilateral PVI was performed under the guidance of 3D‐US geometries and 3D‐Merge CT using the CARTO 3 system (Biosense Webster).…”