title: Moderate Sedation Reduces Lab Time Compared to General Anesthesia during Cryoballoon Ablation for AF Without Compromising Safety or Long-Term Efficacy.
abstract: BACKGROUND
  Cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (pAF) can be performed under general anesthesia (GA) or moderate sedation (MS). Our objective was to compare the effectiveness, safety, procedure duration, and time spent in the electrophysiology (EP) laboratory for CBA performed under GA and MS.
  
  
  METHODS
  Patients undergoing a first CBA for pAF were identified. Patients received either GA administered by an anesthesiologist or MS with midazolam and fentanyl administered by EP laboratory staff. Total time in laboratory (sum of procedure and nonprocedure time); fluoroscopy time; freedom from documented AF, atrial flutter, and atrial tachycardia (FFAF); acute pulmonary vein isolation (PVI) rate; and 30-day complication rate were assessed.
  
  
  RESULTS
  A total of 55 patients received GA and 119 patients received MS. PVI success rate was 100% in GA and 98.1% in MS (P = 0.04). Total laboratory time was longer for GA (280.4 ± 54.1 minutes vs 245.5 ± 54.7 minutes; P < 0.001), related to longer nonprocedure time (92.2 ± 28.8 minutes GA vs 71.0 ± 30.0 minutes MS; P < 0.001), but not procedure time (188.3 ± 49.3 minutes GA vs 174.5 ± 50.2 minutes MS; P = 0.09). FFAF was not significantly different over a median follow-up duration of 0.9 (interquartile range 0.4-1.9) years (61.8% GA vs 63.0% MS; log-rank P = 0.90). There was no significant difference in complication rate.
  
  
  CONCLUSIONS
  Compared to GA, MS during CBA for pAF was independently associated with shorter total EP laboratory time without compromising FFAF or complication rates.
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Wasserlauf
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Knight
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Adin-Cristian
authors.initials: AC
authors.lastname: Andrei
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Rishi
authors.initials: R
authors.lastname: Arora
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Alexandru B
authors.initials: AB
authors.lastname: Chicos
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Goldberger
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lin
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Nishant
authors.initials: N
authors.lastname: Verma
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Martha M
authors.initials: MM
authors.lastname: Bohn
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Passman
mesh_terms: D000768:Anesthesia, General / Q000706:statistics & numerical data*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data; D019411:Clinical Laboratory Techniques; D016292:Procedural Sedation / Q000706:statistics & numerical data*; D017679:Cryotherapy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: anesthesia; atrial fibrillation; catheter ablation; cryoballoon ablation; sedation