Impact of general anesthesia on initiation and stability of VT during catheter ablation

Nof, Eyal; Reichlin, Tobias; Enriquez, Alan D.; Ng, Justin; Nagashima, Koichi; Tokuda, Michifumi; Barbhaiya, Chirag R.; John, Roy M.; Michaud, Gregory F.; Tedrow, Usha B.; Gross, Wendy L.; Stevenson, William G.

doi:10.1016/j.hrthm.2015.06.018

Cited by 41 publications

(28 citation statements)

References 15 publications

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“…A study on general anesthesia during catheter ablation found that an intravenous rather than inhalational anesthetic agents tended to result in more stable VT, although not significantly. 29 Considering various intravenous agents, a case study by Bitar et al 30 from 1988 ( n = 2) found that lidocaine was effective as a deep sedative agent for the termination of VT; however, at our ICU, propofol was the main sedative agent, with concomitant or subsequent infusion of several other agents including fentanyl (Table 1). Furthermore, propofol has been proven valuable and owes its widespread use for sedation to rapid onset of action within 2–3 minutes, short half-life, good amnesic potential and increasing physician familiarity as a preferred drug for inducing sedation in the cardiovascular setting.…”

Section: Discussionmentioning

confidence: 89%

Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm

Bundgaard¹,

Jacobsen²,

Grand³

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background: Electrical storm and incessant ventricular tachycardia (VT) are characterized by the clustering of episodes of VT or ventricular fibrillation (VF) and are associated with a poor prognosis. Autonomic nervous system activity influences VT threshold, and deep sedation may be useful for the treatment of VT emergencies. Methods: We reviewed data from conscious patients admitted to our intensive care unit (ICU) due to monomorphic VT, polymorphic VT or VF at our tertiary center between 2010 and 2018. Results: A total of 46 conscious patients with recurrent ventricular arrhythmia, refractory to initial treatment, were referred to the ICU. The majority ( n = 31) were stabilized on usual care. The remaining treatment-refractory 15 patients (57 years (range 9–74), 80% males, seven with implantable cardioverter-defibrillators) with VT/VF storm ( n = 11) or incessant VT ( n = 4) due to ischemic heart disease ( n = 10), cardiomyopathy ( n = 2), primary arrhythmia ( n = 2) and one patient post valve surgery, were deeply sedated and intubated. A complete resolution of VT/VF within minutes to hours was achieved in 12 patients (80%), partial resolution in two (13%) and one (7%) patient died due to ventricular free-wall rupture. One patient with recurrent VT episodes needing repeated deep sedation developed necrotic caecum. No other major complications were seen. Thirteen (87%) patients were alive after a mean follow-up of 3.7 years. Conclusion: Deep sedation was effective and safe for the temporary management of malignant VT/VF refractory to usual treatment. In emergencies, deep sedation may be widely accessible at both secondary and tertiary centers and a clinically useful bridge to definitive treatment of VT.

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Section: Discussionmentioning

confidence: 89%

Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm

Bundgaard¹,

Jacobsen²,

Grand³

et al. 2020

European Heart Journal. Acute Cardiovascular Care

View full text Add to dashboard Cite

show abstract

“…Therefore, it is likely that sedation contributes to hypotension during induced VT via withdrawal of sympathetic tone. A recently published study corroborated this finding: 61 patients underwent VT induction under conscious sedation and again under GA. Of those inducible for VT under conscious sedation, 8% were noninducible under GA, and an additional 50% had a different morphology of VTs induced under GA. Additionally, the clinical VT was reproduced in 74% of patients under conscious sedation, but only 59% under GA.…”

Section: Discussionmentioning

confidence: 99%

Importance of Ventricular Tachycardia Induction and Mapping for Patients Referred for Epicardial Ablation

Nazer

Woods

Dewland

et al. 2015

Pacing and Clinical Electrophysiology

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“…However, in our experience, VTs are usually well tolerated under general anesthesia in ARVC/D patients if LV ejection fraction is preserved, even in case of RV dysfunction. Data from Nof and colleagues 22 suggested that general anesthesia did not promote noninducibility of VT. For these reasons, general anesthesia remains, in our opinion, the best option for these procedures, especially in young patients.…”

Section: Test Your Knowledge!mentioning

confidence: 97%

Impact of general anesthesia on initiation and stability of VT during catheter ablation

Cited by 41 publications

References 15 publications

Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm

Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm

Importance of Ventricular Tachycardia Induction and Mapping for Patients Referred for Epicardial Ablation

My approach to ventricular tachycardia ablation in patient with arrhythmogenic right ventricular cardiomyopathy/dysplasia

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