title: Impact of general anesthesia on initiation and stability of VT during catheter ablation.
abstract: BACKGROUND
  Radiofrequency ablation of ventricular tachycardia (VT) may be performed with general anesthesia (GA) or conscious sedation; however, comparative data are limited.
  
  
  OBJECTIVE
  The purpose of the study was to assess the effects of GA on VT inducibility and stability.
  
  
  METHODS
  A retrospective comparison of 226 patients undergoing radiofrequency ablation for scar-related VT under GA or intravenous conscious sedation was performed. Data were then prospectively collected in 73 patients undergoing noninvasive programmed stimulation (NIPS) while awake, followed by GA and invasive programmed stimulation for VT induction.
  
  
  RESULTS
  In the retrospective study, groups did not differ in VT inducibility, complications, or abolition of clinical VT. Intravenous hemodynamic support was used more often in the GA group. In the prospective group, 12 patients (16%) were noninducible with NIPS. Of the 61 patients with inducible VT with NIPS, 5 (8%) were noninducible with GA, 25 (41%) were inducible with more aggressive simulation, and 31 (51%) were inducible with the same or less aggressive stimulation. Of the 56 patients who were inducible with NIPS and under GA, 28 (50%) had the same induced VTs and 28 (50%) had different induced VTs. In 23 of 56 patients, the clinical VT morphology was known. The clinical VT was reproduced with NIPS in 17 of 23 patients (74%) and under GA in 13 of 23 patients (59%). Under GA, nonclinical VTs were more often induced in patients with a lower ejection fraction and nonischemic cardiomyopathy.
  
  
  CONCLUSIONS
  GA does not prevent inducible VT in the majority of patients. GA is associated with an increased use of hemodynamic support, but this did not adversely affect VT stability or procedure outcomes.
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: eyal.nof@sheba.health.gov.il.
authors.forename: Eyal
authors.initials: E
authors.lastname: Nof
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; University Hospital Basel, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Enriquez
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Justin
authors.initials: J
authors.lastname: Ng
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michifumi
authors.initials: M
authors.lastname: Tokuda
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Chirag
authors.initials: C
authors.lastname: Barbhaiya
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Usha
authors.initials: U
authors.lastname: Tedrow
authors.affiliation: Department of Cardiac Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Wendy
authors.initials: W
authors.lastname: Gross
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D018780:Body Surface Potential Mapping / Q000379:methods*; D001900:Boston; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007557:Israel; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013557:Switzerland; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Ablation; Conscious sedation; General anesthesia; Hemodynamic support; Programmed stimulation; Ventricular tachycardia