Impact of sedation vs. general anaesthesia on percutaneous epicardial access safety and procedural outcomes.
Patient movement while under moderate/deep sedation may complicate percutaneous epicardial access (EpiAcc), mapping and ablation. We sought to compare procedural outcomes in patients undergoing EpiAcc under sedation vs. general anaesthesia (GA) for ablation.



Patients undergoing EpiAcc between January 2004 and July 2014 were included. Safety, procedural, and clinical outcomes were compared between patients undergoing EpiAcc under sedation or GA for ventricular tachycardia or premature ventricular complex ablation. Between January 2004 and July 2014, 170 patients underwent EpiAcc (mean age, 53.2 ± 15.8 years; average ejection fraction, 44.3 ± 15.3%). The majority (122 [72%] patients) were male. GA was used in 69 (40.6%). There was no difference in route of access (more often anterior, 53.0%) or the rate of successful access (96% overall) between groups. Similarly, the site of ablation (endocardial vs. epicardial vs. combined endocardial/epicardial) was similar between groups. Complications were equally seen between groups-the most frequent event/complication was pericardial effusion, occurring in 10.6% of patients. Finally, procedural and clinical success rates between GA and sedation groups were comparable (93 vs. 91% and 44 vs. 51%, respectively, P > 0.05).



Choice of anaesthesia for EpiAcc does not appear to significantly affect safety and procedural or clinical outcomes. For patients in whom anaesthesia may pose increased risk, it is reasonable to obtain epicardial access under sedation.
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.|Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Ammar M
AM
Killu
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Alan
A
Sugrue
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.|Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Thomas M
TM
Munger
Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA.
David O
DO
Hodge
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.|Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Siva K
SK
Mulpuru
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.|Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Christopher J
CJ
McLeod
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.|Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Douglas L
DL
Packer
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.|Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.|Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
Samuel J
SJ
Asirvatham
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.|Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Paul A
PA
Friedman
D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D017115:Catheter Ablation / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects; D054810:Deep Sedation / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
Ablation; Anaesthesia; Epicardial; Percutaneous; Sedation; Ventricular tachycardia