Impact of different type of anesthesia on acute efficacy of pulmonary vein isolation by means of very high power short duration radiofrequency ablation

Different type of anesthesia can be adopted during pulmonary vein isolation (PVI). Although general anesthesia (GA) may improve catheter stability however many EP labs lack of anesthesiologists availability, thus a conscious/deep sedation is adopted. Moreover, in the very high power short duration (vHPSD) ablation era, there are no clear evidence of the superiority of one over the other.

We sought to investigate in a large cohort of atrial fibrillation (AF) patients the impact of different type of anesthesia on the procedural outcomes.

The AIR HPSD Registry is a multicentric study including AF patients undergoing their first PVI procedure by mean of the QDOT Micro catheter across 22 European centers. The QDOT Micro catheter (Biosense Webster, Inc CA) enables the ablation in the Qmode+ modality (90 W for 4 sec) and/or in the Qmode modality, 50 W ablation index (AI)-guided. The ablation modality (hybrid/ Qmode+) and the type of anesthesia were left to operators’ preference.

Overall, 917 patients have been enrolled, 72% males, 70% had paroxysmal AF, the mean age was 62±10 years. Pulmonary vein isolation was reached in 100% regardless of the ablation modality. The rate of first pass isolation (FPI) was similar between patients ablated under general anesthesia (GA) and those ablated under conscious/deep sedation (76% vs. 75.5%, p=ns). When dividing the patients based on the ablation modality, in the Qmode+ group there was a trend toward higher rate of FPI in the GA group (79% vs. 73%; p=0.058), conversely no differences were found in the hybrid group.

The procedural time was shorter in the GA group (97±36 vs. 106±42 min, p<0.01) whereas the fluoroscopy time was similar between the two groups (315±467 min vs. 339±409 sec, p=ns). Furthermore, No differences in the rate of complications were observed between the two groups (0% vs. 1,4%, p=ns).

The type of anesthesia doesn’t impact on the procedural efficacy and safety of the vHPSD ablation, however the use of GA shortens the overall procedural time.