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

Luigi Di Biase, Sergio Conti, Prasant Mohanty, Rong Bai, Javier Sanchez, David Walton, Annie John, Pasquale Santangeli, Claude S. Elayi, Salwa Beheiry, G. Joseph Gallinghouse, Sanghamitra Mohanty, Rodney Horton, Shane Bailey, J. David Burkhardt, Andrea Natale

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

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). Conclusion 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.

Original languageEnglish (US)
Pages (from-to)368-372
Number of pages5
JournalHeart Rhythm
Volume8
Issue number3
DOIs
StatePublished - Mar 2011
Externally publishedYes

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Conscious Sedation
Pulmonary Veins
General Anesthesia
Atrial Fibrillation
Catheter Ablation
Anti-Arrhythmia Agents
Fluoroscopy
Midazolam
Fentanyl
Isoproterenol
Cardiac Arrhythmias
Physicians
Recurrence

Keywords

  • Conscious sedation
  • General anesthesia
  • Outcomes
  • Paroxysmal AF
  • Recurrences

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation : Results from a randomized study. / Di Biase, Luigi; Conti, Sergio; Mohanty, Prasant; Bai, Rong; Sanchez, Javier; Walton, David; John, Annie; Santangeli, Pasquale; Elayi, Claude S.; Beheiry, Salwa; Gallinghouse, G. Joseph; Mohanty, Sanghamitra; Horton, Rodney; Bailey, Shane; Burkhardt, J. David; Natale, Andrea.

In: Heart Rhythm, Vol. 8, No. 3, 03.2011, p. 368-372.

Research output: Contribution to journalArticle

Di Biase, L, Conti, S, Mohanty, P, Bai, R, Sanchez, J, Walton, D, John, A, Santangeli, P, Elayi, CS, Beheiry, S, Gallinghouse, GJ, Mohanty, S, Horton, R, Bailey, S, Burkhardt, JD & Natale, A 2011, 'General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: Results from a randomized study', Heart Rhythm, vol. 8, no. 3, pp. 368-372. https://doi.org/10.1016/j.hrthm.2010.10.043
Di Biase, Luigi ; Conti, Sergio ; Mohanty, Prasant ; Bai, Rong ; Sanchez, Javier ; Walton, David ; John, Annie ; Santangeli, Pasquale ; Elayi, Claude S. ; Beheiry, Salwa ; Gallinghouse, G. Joseph ; Mohanty, Sanghamitra ; Horton, Rodney ; Bailey, Shane ; Burkhardt, J. David ; Natale, Andrea. / General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation : Results from a randomized study. In: Heart Rhythm. 2011 ; Vol. 8, No. 3. pp. 368-372.
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abstract = "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). Conclusion 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.",
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T1 - General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation

T2 - Results from a randomized study

AU - Di Biase, Luigi

AU - Conti, Sergio

AU - Mohanty, Prasant

AU - Bai, Rong

AU - Sanchez, Javier

AU - Walton, David

AU - John, Annie

AU - Santangeli, Pasquale

AU - Elayi, Claude S.

AU - Beheiry, Salwa

AU - Gallinghouse, G. Joseph

AU - Mohanty, Sanghamitra

AU - Horton, Rodney

AU - Bailey, Shane

AU - Burkhardt, J. David

AU - Natale, Andrea

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N2 - 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). Conclusion 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.

AB - 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). Conclusion 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.

KW - Conscious sedation

KW - General anesthesia

KW - Outcomes

KW - Paroxysmal AF

KW - Recurrences

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