A Comparison Between Sedation And General Anesthesia In Radiofrequency Ablation Of Atrial Fibrillation

Background and Objective:Atrial fibrillationas the most common sustained cardiac arrhythmia,significantly increases the risk of stroke,heart failure,and mortality.The Catheter ablation with a high cure rate and exact effect,now has been widely used in clinical.The operation time for radiofrequency catheter ablation of atrial fibrillation is generally 2 ~ 4 hours during which patients have to be immobilized in order to increase the stability of catheter and improve the success rate of ablation.In addition,radiofrequency ablation of atrial fibrillation catheter is an invasive,thermal ablation surgery.the ablation temperature of catheter tip is generally controlled at 39-42 ?,sometimes even higher,which may cause unbearable discomfort or pain to awake patients.Accidental body movements caused by pain or coughing can lead to reduced accuracy of the mapping system or disruption of surgery,even serious complications.Therefore,most radiofrequency catheter ablations of atrial fibrillation is performed under sedation or general anesthesia.Anesthetic techniques are used differently by the centres around the world,even in the same centre.Although there were a number of scholars compared the pros and cons of the radiofrequency catheter ablation procedure for sedation and general anesthesia,some problems remain unclear.There were few researches on the complications following radiofrequency catheter ablation at home and abroad,and there were also differences in the recurrence rate of atrial fibrillation.In addition,since most of the relevant studies belonged to the single center study,the accuracy of these findings needs to be tested.Therefore,it is important to provide more central findings to clarify the impact of different anesthetic protocols on radiofrequency catheter ablation of atrial fibrillation.This subject analyzed retrospectively the data of patients underwent radiofrequency catheter ablation for atrial fibrillation in our hospital in recent years.Surgical implementation,perioperative complications and postoperative recurrence rate for the operation of atrial fibrillation catheter ablation were compared based on the choice of anesthesia program.Aimed to provide more accurate guidance for the selection of anesthetic scheme for radiofrequency catheter ablation of atrial fibrillation.Methods: This is a retrospective study.Using the electronic medical record consulting system and the cardiac medical record consulting system of Dalian Medical University.and according to the inclusion and exclusion criteria,a total of 561 patients underwent radiofrequency catheter ablation of atrial fibrillation in our hospital,from June 2013 to June 2016,were included.The cases were divided into conscious sedation group and general anesthesia group.There were 237 patients in conscious sedation group(116 patients with paroxysmal atrial fibrillation and 71 patients with persistent atrial fibrillation)and 324 patients in general anesthesia group(94 patients with paroxysmal atrial fibrillation and 230 patients with persistent atrial fibrillation).Patients in the sedation group were given midazolam 2-4mg intravenous infusion,followed by a continuous infusion of fentanyl 1-3ug/(kg·h),maintaining a Ramsay score of 2-3 points.Patients in general anesthesia group were induced to use midazolam 1-2mg,etomidate 0.2-0.4mg/kg,Sufentanil 0.2-0.4ug/kg,cis-atracurium ammonium 0.15-0.2mg/kg intravenous injection.Tracheal intubation and mechanical ventilation were completed after anesthesia induction.The anesthesia depth was sustained by propofol 3~6mg/(kg·h),Remifentanil 0.1~0.3ug/(kg·min),and Atracurium ammonium 0.1mg/(kg·h).Ablation were operated under the guidance of the CARTO-3 system.The procedure time,ablation time,fluoroscopy time,immediate success rate,hospitalization time,operation and anesthesia complication rate and the recurrence rate of atrial fibrillation in 3rd,6 and 12 months after operation were compared between the two groups.Results:(1)There were no significant difference in sex,age,body weight,ASA classification,AF type,preoperative complications,imaging and other basic information between the two groups.(2)Operation related index: the operation time and ablation time of general anesthesia group were less than that of conscious sedation group,with statistically differences.Between the two groups,the time of fluoroscopy,the immediate success rate of ablation and hospitalization time were similar,without statistically significant.(3)Complications: The incidence of postoperative nausea and vomiting in general anesthesia group was significantly lower than that in conscious sedation group.There were no statistical difference between the two groups in Severe intraoperative pain,hypoxemia,pericardial tamponade,postoperative pharyngeal discomfort,chest pain,vascular injury,pulmonary infection,thromboembolism,atrial esophageal fistula,etc.(4)Postoperative follow-up: The total recurrence rate of atrial fibrillation was similar in the 3rd,6 and 12 months after the patients with conscious sedation Group and general anesthesia Group,but there was no statistically difference.The recurrence rate of AF in the 3rd and 6 months after the patients with paroxysmal atrial fibrillation was similar,without statistically significant difference.However,during the 12 th month of the operation,the recurrence rate of AF in patients with conscious sedation group was higher than that in general anesthesia group,and the recurrence rate of atrial fibrillation was similar in the 3rd,6 and 12 months after continuous atrial fibrillation between the two groups,without statistically significant difference.Conclusion: Radiofrequency catheter ablation of atrial fibrillation can be safely performed under conscious sedation and general anesthesia.General anesthesia regimen has more advantages than conscious sedation regimen in terms of operative time and ablation time.Intraoperative administration of 5-TH3 receptor antagonist can decrease the incidence of postoperative nausea and vomiting.There was no significant difference in the recurrence rate of atrial fibrillation within 12 months after radiofrequency catheter ablation of the atrial fibrillation under conscious sedation or general anesthesia regimen. General anesthesia regimen can reduce the recurrence rate of atrial fibrillation in patients with paroxysmal atrial fibrillation at 12 months,however,there was no significant effect on postoperative atrial fibrillation recurrence rate in patients with persistent atrial fibrillation.