• Rachel S Dada, HayangaJ W AworiJWADepartment of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV., Kaitlin Woods, David Schwartzman, Dylan Thibault, Matthew Ellison, Stanley Schmidt, Donald Siddoway, Vinay Badhwar, and Heather K Hayanga.
• Department of Anesthesiology, West Virginia University, Morgantown, WV.
• J. Cardiothorac. Vasc. Anesth. 2021 Sep 1; 35 (9): 2600-2606.

ObjectiveThe authors evaluated the type of anesthesia administered in atrial fibrillation ablation, hypothesizing that monitored anesthesia care is used less frequently than general anesthesia.DesignA retrospective study.SettingNational Anesthesia Clinical Outcomes Registry data, which are multi-institutional from across the United States.ParticipantsAdult patients who underwent elective atrial fibrillation ablation between 2013 and 2018.InterventionsNone.Measurements And Main ResultsNational Anesthesia Clinical Outcomes Registry data were evaluated, and covariates were selected a priori within multivariate models to assess for predictors of anesthetic type. A total of 54,321 patients underwent atrial fibrillation ablation; 3,251 (6.0%) received monitored anesthesia care. Patients who received monitored anesthesia care were more likely to be >80 years old (12.4% v 4.9%; p < 0.0001), female (36.1% v 34.3%; p < 0.0001), have American Society of Anesthesiologists physical status >III (17.28% v 10.48%; p < 0.0001), and reside in urban areas (62.23% v 53.37%; p < 0.0001). They received care in the Northeast (17.6% v 10.1%; p < 0.0001) at low-volume centers (median 224 v 284 procedures; p < 0.0001). Multivariate analysis revealed that each five-year increase in age, being female, and having an American Society of Anesthesiologists physical status >III resulted in a 7% (p < 0.0001), 9% (p = 0.032), and 200% (p < 0.0001) increased odds of receiving monitored anesthesia care, respectively. Requiring additional ablation of atria or of a second arrhythmia and residing outside the Northeast resulted in a decreased odds of monitored anesthesia care (adjusted odds ratio 0.24 [p=0.002] and < 0.5 [p < 0.03], respectively). For each 50 cases performed annually at a center, the odds decreased by 5% (p = 0.005).ConclusionsGeneral anesthesia is the most common type of anesthesia administered for atrial fibrillation ablation. The type of anesthesia administered, however, varies with patient, procedural, and hospital characteristics.Copyright © 2021 Elsevier Inc. All rights reserved.

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