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J. Cardiothorac. Vasc. Anesth. · Nov 2024
Review Comparative StudyAnesthetic Techniques for Ablation in Atrial Fibrillation: A Comparative Review.
General anaesthesia, particularly with optimised ventilation strategies (either HFJV or HFLTV), appears to improve AF ablation outcomes through enhanced catheter stability.
pearl- Paul Ford, Andrew Russell Cheung, Maaz Shah Khan, Gabriella Rollo, Samata Paidy, Mathew Hutchinson, and Rabail Chaudhry.
- Banner University Medical Center, Department of Anesthesiology and Pain Medicine, University of Arizona COM-T, Tucson, Arizona.
- J. Cardiothorac. Vasc. Anesth. 2024 Nov 1; 38 (11): 275427602754-2760.
AbstractAtrial fibrillation, the most prevalent cardiac arrhythmia, has witnessed significant advancements in treatment modalities, transitioning from invasive procedures like the maze procedure to minimally invasive catheter ablation techniques. This review focuses on recent improvements in anesthetic approaches that enhance outcomes in catheter atrial fibrillation ablation. We highlight the efficacy of contact force sensing catheters with steerable introducer sheaths, which outperform traditional catheters by ensuring more effective contact time and lesion formation. Comparing general anesthesia with conscious sedation, we find that general anesthesia provides superior catheter stability due to reduced respiratory variability, resulting in more effective lesion formation, and reduced pulmonary vein reconnection. The use of high-frequency jet ventilation under general anesthesia, delivering low tidal volumes, effectively minimizes left atrial movement, decreasing catheter displacement and procedure time, and reducing recurrence in paroxysmal atrial fibrillation. An alternative, high-frequency low tidal volume ventilation using conventional ventilators, also shows improved catheter stability and lesion durability compared to traditional ventilation methods. However, a detailed comparative study of high-frequency jet ventilation, high-frequency low tidal volume ventilation, and conventional mechanical ventilation in catheter ablation for atrial fibrillation is lacking. This review emphasizes the need for such studies to identify optimal anesthetic techniques, potentially enhancing patient outcomes in atrial fibrillation treatment. Our findings suggest that careful selection of anesthetic methods, including ventilation strategies, plays a crucial role in the success of catheter ablation for atrial fibrillation, warranting further research for evidence-based practice.Copyright © 2024 Elsevier Inc. All rights reserved.
Notes
This narrative review by Ford et al. examines how anaesthetic technique impacts the success of catheter ablation for atrial fibrillation (AF). With AF being the most common cardiac arrhythmia and ablation procedures increasingly common, understanding optimal anaesthetic approaches is crucial for improving patient outcomes.
The authors compare three key approaches: general anaesthesia (GA) versus conscious sedation, high-frequency jet ventilation (HFJV), and high-frequency low tidal volume ventilation (HFLTV).
The evidence strongly favours GA over conscious sedation, with one study showing significantly better arrhythmia-free rates at 17 months (88% vs 69%). Both HFJV and HFLTV show promise in improving catheter stability and procedural outcomes through reduced respiratory variability, though HFJV faces practical challenges including cost and training requirements.
While the review acknowledges the need for randomised controlled trials comparing different ventilation strategies, it makes a compelling argument for anaesthetic techniques that minimise ventilation variability. HFLTV might offer a practical middle ground, potentially providing similar benefits to HFJV without the associated costs and training demands.
Daniel Jolley
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