Usefulness of intravenous propofol anesthesia for radiofrequency catheter ablation in patients with tachyarrhythmias: infeasibility for pediatric patients with ectopic atrial tachycardia.
General anesthesia is sometimes required during radiofrequency catheter ablation (RFCA) of various tachyarrhythmias because of an anticipated prolonged procedure and the need to ensure stability during critical ablation. In this study, we examine the feasibility of using propofol anesthesia for RFCA procedure. There were 150 patients (78 male, 72 female; mean age 30 years, range 4-96 years) in the study. Electrophysiologic study was performed before and during propofol infusion in the initial 20 patients and was performed only during propofol infusion in the remaining 130 patients. In the initial 20 patients, propofol infusion increased the sinus rate and facilitated AV nodal conduction. The accessory pathway effective refractory period, as well as the sinus node recovery time, atrial effective refractory period, and ventricular effective refractory period were not significantly changed. There were 152 tachyarrhythmias in 150 patients (24 atrial flutter, 31 AV nodal reentrant tachycardia, 68 AV reciprocating tachycardia, 12 ventricular tachycardia, and 17 atrial tachycardia). Most (148/152) tachycardias remained inducible after anesthesia and RFCA was performed uneventfully. However, in four of the seven pediatric patients with ectopic atrial tachycardia, the tachycardia terminated after propofol infusion and could not be induced by isoproterenol infusion. Consequently, RFCA could not be performed. Intravenous propofol anesthesia is feasible during RFCA for most tachyarrhythmias except for ectopic atrial tachycardia in children.
Lai
L P
LP
Department of Internal Medicine, National Taiwan University Hospital, Taipei.
Lin
J L
JL
Wu
M H
MH
Wang
M J
MJ
Huang
C H
CH
Yeh
H M
HM
Tseng
Y Z
YZ
Lien
W P
WP
Huang
S K
SK
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology; D013612:Tachycardia, Ectopic Atrial / Q000503:physiopathology / Q000601:surgery*
D018686:Anesthetics, Intravenous; D015742:Propofol