General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study.
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).


CONCLUSIONS
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.
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas 78705, USA.
Luigi
L
Di Biase
Sergio
S
Conti
Prasant
P
Mohanty
Rong
R
Bai
Javier
J
Sanchez
David
D
Walton
Annie
A
John
Pasquale
P
Santangeli
Claude S
CS
Elayi
Salwa
S
Beheiry
G Joseph
GJ
Gallinghouse
Sanghamitra
S
Mohanty
Rodney
R
Horton
Shane
S
Bailey
J David
JD
Burkhardt
Andrea
A
Natale
D000368:Aged; D000768:Anesthesia, General; D001281:Atrial Fibrillation / Q000601:surgery*; D016292:Procedural Sedation; D005260:Female; D005471:Fluoroscopy; D006611:High-Frequency Jet Ventilation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012086:Reoperation