Moderate Sedation Reduces Lab Time Compared to General Anesthesia during Cryoballoon Ablation for AF Without Compromising Safety or Long-Term Efficacy

Jeremiah Wasserlauf, Bradley P. Knight, Zhi Li, Adin Cristian Andrei, Rishi Arora, Alexandru B. Chicos, Jeffrey Goldberger, Susan S. Kim, Albert C. Lin, Nishant Verma, Martha M. Bohn, Rod S. Passman

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (pAF) can be performed under general anesthesia (GA) or moderate sedation (MS). Our objective was to compare the effectiveness, safety, procedure duration, and time spent in the electrophysiology (EP) laboratory for CBA performed under GA and MS. Methods: Patients undergoing a first CBA for pAF were identified. Patients received either GA administered by an anesthesiologist or MS with midazolam and fentanyl administered by EP laboratory staff. Total time in laboratory (sum of procedure and nonprocedure time); fluoroscopy time; freedom from documented AF, atrial flutter, and atrial tachycardia (FFAF); acute pulmonary vein isolation (PVI) rate; and 30-day complication rate were assessed. Results: A total of 55 patients received GA and 119 patients received MS. PVI success rate was 100% in GA and 98.1% in MS (P = 0.04). Total laboratory time was longer for GA (280.4 ± 54.1 minutes vs 245.5 ± 54.7 minutes; P < 0.001), related to longer nonprocedure time (92.2 ± 28.8 minutes GA vs 71.0 ± 30.0 minutes MS; P < 0.001), but not procedure time (188.3 ± 49.3 minutes GA vs 174.5 ± 50.2 minutes MS; P = 0.09). FFAF was not significantly different over a median follow-up duration of 0.9 (interquartile range 0.4–1.9) years (61.8% GA vs 63.0% MS; log-rank P = 0.90). There was no significant difference in complication rate. Conclusion: Compared to GA, MS during CBA for pAF was independently associated with shorter total EP laboratory time without compromising FFAF or complication rates.

Original languageEnglish (US)
Pages (from-to)1359-1365
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume39
Issue number12
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

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Conscious Sedation
General Anesthesia
Safety
Electrophysiology
Atrial Fibrillation
Pulmonary Veins
Atrial Flutter
Fluoroscopy
Midazolam
Fentanyl
Tachycardia

Keywords

  • anesthesia
  • atrial fibrillation
  • catheter ablation
  • cryoballoon ablation
  • sedation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Moderate Sedation Reduces Lab Time Compared to General Anesthesia during Cryoballoon Ablation for AF Without Compromising Safety or Long-Term Efficacy. / Wasserlauf, Jeremiah; Knight, Bradley P.; Li, Zhi; Andrei, Adin Cristian; Arora, Rishi; Chicos, Alexandru B.; Goldberger, Jeffrey; Kim, Susan S.; Lin, Albert C.; Verma, Nishant; Bohn, Martha M.; Passman, Rod S.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 39, No. 12, 01.12.2016, p. 1359-1365.

Research output: Contribution to journalArticle

Wasserlauf, J, Knight, BP, Li, Z, Andrei, AC, Arora, R, Chicos, AB, Goldberger, J, Kim, SS, Lin, AC, Verma, N, Bohn, MM & Passman, RS 2016, 'Moderate Sedation Reduces Lab Time Compared to General Anesthesia during Cryoballoon Ablation for AF Without Compromising Safety or Long-Term Efficacy', PACE - Pacing and Clinical Electrophysiology, vol. 39, no. 12, pp. 1359-1365. https://doi.org/10.1111/pace.12961
Wasserlauf, Jeremiah ; Knight, Bradley P. ; Li, Zhi ; Andrei, Adin Cristian ; Arora, Rishi ; Chicos, Alexandru B. ; Goldberger, Jeffrey ; Kim, Susan S. ; Lin, Albert C. ; Verma, Nishant ; Bohn, Martha M. ; Passman, Rod S. / Moderate Sedation Reduces Lab Time Compared to General Anesthesia during Cryoballoon Ablation for AF Without Compromising Safety or Long-Term Efficacy. In: PACE - Pacing and Clinical Electrophysiology. 2016 ; Vol. 39, No. 12. pp. 1359-1365.
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abstract = "Background: Cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (pAF) can be performed under general anesthesia (GA) or moderate sedation (MS). Our objective was to compare the effectiveness, safety, procedure duration, and time spent in the electrophysiology (EP) laboratory for CBA performed under GA and MS. Methods: Patients undergoing a first CBA for pAF were identified. Patients received either GA administered by an anesthesiologist or MS with midazolam and fentanyl administered by EP laboratory staff. Total time in laboratory (sum of procedure and nonprocedure time); fluoroscopy time; freedom from documented AF, atrial flutter, and atrial tachycardia (FFAF); acute pulmonary vein isolation (PVI) rate; and 30-day complication rate were assessed. Results: A total of 55 patients received GA and 119 patients received MS. PVI success rate was 100{\%} in GA and 98.1{\%} in MS (P = 0.04). Total laboratory time was longer for GA (280.4 ± 54.1 minutes vs 245.5 ± 54.7 minutes; P < 0.001), related to longer nonprocedure time (92.2 ± 28.8 minutes GA vs 71.0 ± 30.0 minutes MS; P < 0.001), but not procedure time (188.3 ± 49.3 minutes GA vs 174.5 ± 50.2 minutes MS; P = 0.09). FFAF was not significantly different over a median follow-up duration of 0.9 (interquartile range 0.4–1.9) years (61.8{\%} GA vs 63.0{\%} MS; log-rank P = 0.90). There was no significant difference in complication rate. Conclusion: Compared to GA, MS during CBA for pAF was independently associated with shorter total EP laboratory time without compromising FFAF or complication rates.",
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T1 - Moderate Sedation Reduces Lab Time Compared to General Anesthesia during Cryoballoon Ablation for AF Without Compromising Safety or Long-Term Efficacy

AU - Wasserlauf, Jeremiah

AU - Knight, Bradley P.

AU - Li, Zhi

AU - Andrei, Adin Cristian

AU - Arora, Rishi

AU - Chicos, Alexandru B.

AU - Goldberger, Jeffrey

AU - Kim, Susan S.

AU - Lin, Albert C.

AU - Verma, Nishant

AU - Bohn, Martha M.

AU - Passman, Rod S.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background: Cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (pAF) can be performed under general anesthesia (GA) or moderate sedation (MS). Our objective was to compare the effectiveness, safety, procedure duration, and time spent in the electrophysiology (EP) laboratory for CBA performed under GA and MS. Methods: Patients undergoing a first CBA for pAF were identified. Patients received either GA administered by an anesthesiologist or MS with midazolam and fentanyl administered by EP laboratory staff. Total time in laboratory (sum of procedure and nonprocedure time); fluoroscopy time; freedom from documented AF, atrial flutter, and atrial tachycardia (FFAF); acute pulmonary vein isolation (PVI) rate; and 30-day complication rate were assessed. Results: A total of 55 patients received GA and 119 patients received MS. PVI success rate was 100% in GA and 98.1% in MS (P = 0.04). Total laboratory time was longer for GA (280.4 ± 54.1 minutes vs 245.5 ± 54.7 minutes; P < 0.001), related to longer nonprocedure time (92.2 ± 28.8 minutes GA vs 71.0 ± 30.0 minutes MS; P < 0.001), but not procedure time (188.3 ± 49.3 minutes GA vs 174.5 ± 50.2 minutes MS; P = 0.09). FFAF was not significantly different over a median follow-up duration of 0.9 (interquartile range 0.4–1.9) years (61.8% GA vs 63.0% MS; log-rank P = 0.90). There was no significant difference in complication rate. Conclusion: Compared to GA, MS during CBA for pAF was independently associated with shorter total EP laboratory time without compromising FFAF or complication rates.

AB - Background: Cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (pAF) can be performed under general anesthesia (GA) or moderate sedation (MS). Our objective was to compare the effectiveness, safety, procedure duration, and time spent in the electrophysiology (EP) laboratory for CBA performed under GA and MS. Methods: Patients undergoing a first CBA for pAF were identified. Patients received either GA administered by an anesthesiologist or MS with midazolam and fentanyl administered by EP laboratory staff. Total time in laboratory (sum of procedure and nonprocedure time); fluoroscopy time; freedom from documented AF, atrial flutter, and atrial tachycardia (FFAF); acute pulmonary vein isolation (PVI) rate; and 30-day complication rate were assessed. Results: A total of 55 patients received GA and 119 patients received MS. PVI success rate was 100% in GA and 98.1% in MS (P = 0.04). Total laboratory time was longer for GA (280.4 ± 54.1 minutes vs 245.5 ± 54.7 minutes; P < 0.001), related to longer nonprocedure time (92.2 ± 28.8 minutes GA vs 71.0 ± 30.0 minutes MS; P < 0.001), but not procedure time (188.3 ± 49.3 minutes GA vs 174.5 ± 50.2 minutes MS; P = 0.09). FFAF was not significantly different over a median follow-up duration of 0.9 (interquartile range 0.4–1.9) years (61.8% GA vs 63.0% MS; log-rank P = 0.90). There was no significant difference in complication rate. Conclusion: Compared to GA, MS during CBA for pAF was independently associated with shorter total EP laboratory time without compromising FFAF or complication rates.

KW - anesthesia

KW - atrial fibrillation

KW - catheter ablation

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KW - sedation

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