Abstract 628: Triggers of Atrial Fibrillation are Suppressed in the Setting of General Anesthesia
Introduction: The elimination of triggers initiating atrial fibrillation (AF) with catheter ablation is an effective method for treating this arrhythmia. Therefore reliable identification and successful elimination of triggers remains an important feature to this strategy. However, it is unclear whether deep sedation with general anesthesia will affect AF trigger identification. We hypothesized that deep sedation with general anesthesia would reduce the number of AF triggers identified compared to patients undergoing moderate (conscious) sedation.
Methods: 43 consecutive patients undergoing AF trigger identification and ablation were included in the cohort. The level of sedation administered was determined prior to AF trigger identification based on physician and/or patient preference. Triggers of AF were identified prospectively with isoproterenol infusion (up to 20 mcg/min) and defined as PV or Non-PV in origin. Deep sedation with general anesthesia was defined as lack of patient response to painful stimuli and the requirement of intubation. The anesthetic agents used in deep sedation included midazolam, fentanyl, propofol, vecuronium, and halothane. Patients undergoing moderate sedation remained conscious throughout the procedure and were administered fentanyl, midazolam, and propofol. Comparisons were made between these two groups. Multivariable logistic regression was used to identify predictors of AF trigger identification.
Results: AF triggers were identified in 26 subjects (60%) of the 43 included in the analysis. AF triggers were identified in 7/23 (32%) of patients receiving general anesthesia compared to AF trigger identification in 19/20 (93%) of the patients receiving moderate sedation. Of all potential covariates tested, including age, sex, AF subtype, LA size, LV EF, and other cardiac risk factors, only deep sedation was associated with lack of identification of AF triggers (Risk ratio 0.43; 95% confidence interval 0.27, 0.74; P=.002).
Conclusions: Deep sedation with general anesthesia and mechanical ventilation will suppress PV ectopy and other triggers of AF. Consideration to this phenomenon should be given when selective PV isolation and/or non-PV trigger ablation is used as an ablation strategy.