ANESTHESIA DURING ATRIAL FIBRILLATION ABLATION : FIRST EXPERIENCE AND LITERATURE REVIEW

Background: General anesthesia is mostly performed for radiofrequency ablation for atrial fibrillation. Deep sedation is required for cryoablation. The ideal anesthetic protocol is unknown. We sought to report our anesthetic protocol used for the anesthesia of atrial fibrillation (AF) ablations as the first experience of our University Hospital over one year, with a literature review on anesthetic considerations to accompany AF ablations.

Methods : anesthetic procedure begins with ergonomic layout of the cathlab. All patients who underwent AF ablation between January 2023 and January 2024 were identified prospectively in the cohort study. Our anesthetic protocol consists of midazolam and propofol as hypnotic agents and fentanyl for analgesia. Rocuronium is provided for general anesthesia. Intubation is required for general anesthesia. Patient is extubated once meeting standard criteria. Procedural complications are collected.

Results: A total of 24 patients underwent AF ablation from January 2023 to January 2024. The average age was 60 years, with 62% women and 38% men (paroxysmal AF 51%, CHADS2VASC 1.17). The total duration of the procedures was between 2 and 2,5 hours. The median time to extubation was 25 minutes once the procedure was completed, with a total anesthesia time averaging 140 minutes. Three patients were recovered to general anesthesia. No other anesthesia-related complications were seen.

Conclusion: Our anesthetic protocol is specifically designed for AF ablation. General anesthesia was safer than sedation, with no significant difference for efficient recovery and extubation times. Other protocols can be tested to avoid intubation. It is also necessary for anesthesiologists to optimize the space of cathlabs for safe use.