title: General anesthesia improves contact force and reduces gap formation in pulmonary vein isolation: a comparison with conscious sedation.
abstract: Compared to conscious sedation (CS), the use of general anesthesia (GA) in pulmonary vein isolation (PVI) is associated with a lower recurrence rate of atrial fibrillation (AF). GA may improve catheter stability and mapping system accuracy compared to CS, but its influence on contact force (CF) parameters during ipsilateral PVI has not previously been investigated. The study population comprised 176 consecutive patients (107 in GA group and 69 in CS group) with AF who underwent their first PVI procedure. We retrospectively assessed CF parameters, force-time integral (FTI), FTI/wall thickness during anatomical ipsilateral PVI and long-term outcome after ablation. Complete PVI with single continuous circular lesions around the ipsilateral PVs was achieved in 54 patients (50.5%) in the GA group but only 24 patients (34.8%) in the CS group (P = 0.04). The distribution of gaps did not differ between the groups. All CF parameters were significantly higher in the GA group than in the CS group (average CF: 19.4 ± 8.7 vs. 16.7 ± 7.7 g, P < 0.0001; FTI: 399.0 ± 262.5 vs. 293.9 ± 193.4 gs, P < 0.0001; FTI/wall thickness: 155.5 ± 106.1 vs. 115.7 ± 85.5 gs, P < 0.0001). GA was associated with lower AF recurrence rate in patients with paroxysmal AF but not with persistent AF. Compared with CS, GA improves CF parameters, FTI and FTI/wall thickness, and reduced gap formation after ipsilateral PVI.
authors.affiliation: Department of System Biology, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.|Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Chikata
authors.affiliation: Department of System Biology, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan. takeshikato@me.com.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of System Biology, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.|Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Yaegashi
authors.affiliation: Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Sakagami
authors.affiliation: Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan.
authors.forename: Chieko
authors.initials: C
authors.lastname: Kato
authors.affiliation: Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Saeki
authors.affiliation: Department of Radiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Department of System Biology, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Shin-Ichiro
authors.initials: SI
authors.lastname: Takashima
authors.affiliation: Department of System Biology, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Murai
authors.affiliation: Department of System Biology, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Usui
authors.affiliation: Department of System Biology, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furusho
authors.affiliation: Department of System Biology, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneko
authors.affiliation: Department of System Biology, Kanazawa University Graduate School of Advanced Preventive Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Takamura
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Atrial fibrillation; Contact force; Force–time integral; General anesthesia; Pulmonary vein isolation