Ventricular tachycardia ablation under general anesthesia is strongly associated with severe systemic hypotension events: role of non-invasive continue hemodynamic monitoring

Periprocedural hypotension is associated with poor outcomes during non-cardiac general anesthesia (GA)-surgery. Ventricular tachycardia (VT) endo-epi ablation is a long duration electrophysiological procedure usually performed in fragile patients, potentially at high risk of general anesthesia (GA) and ventricular arrhythmias related systemic hypotensions.

Aim of the study was the evaluate blood pressure (BP) trends during GA VT ablation using a dedicated hemodynamic platform and non-invasive finger cuff sensor (Acumen IQ), which allow, using a pulse contour analysis, a countinous hemodynamic monitoring including an hypotensive prediction index (HPI) estimation.

Sixteen patients underwent VT transcatheter ablation on general anesthesia at Pisa University Hospital were prospectively candidate to be ablated under the HemoSphere advanced monitoring. Blood pressure and hemodynamical parameter trends were recorded during the entire procedure. Hypotension was defined as MAP less than 65 mmHg and severe hypotensionas MAP less than 50 mmHg.

A total of 16 patients were included (93.75% female, mean age 58 years). Monitoring time per patient was 271 +/- 115 minutes. Number of patients with hypotension with MAP < 65 mmHg was 12 out of 16 (75%). The total number of hypotensive events in dataset was 153 with an average number of 10 hypotensive events per patient and an average duration of each 6 +/- 8 minutes per event. Total duration of hypotensive events per patient was 59.7 minutes with time weighted average for MAP < 65 mmHg of 0.37 mmHg. Severe hypotension (MAP < 50 mmHg) was observed in 4 out of 16 (25%), lasting 2.6 +/- minutes per patient. All hypotensions (100 %) were associated and or predicted by an HPI change.

VT ablation under GA is associated with long period of anesthesiological and/or arrhythmia related hypotensions, predicted by HPI.Figure 1  Figure 2