General Anesthesia is Not Superior to Local Anesthesia for Remote Magnetic Ablation of Atrial Fibrillation SOK-SITHIKUN BUN, M.D., DECEBAL GABRIEL LATCU, M.D., EMNA ALLOUCHE, M.D., ABDELKARIM ERRAHMOUNI, M.D., and NADIR SAOUDI, M.D. From the Department of Cardiology, Princess Grace Hospital, Monaco (Principality)

Background: Remote magnetic navigation is an emerging technology for atrial fibrillation (AF) ablation. General anesthesia (GA) has shown to be superior to local anesthesia (LA) for manual AF ablation in terms of catheter stability and lesion formation. We aimed at comparing GA with LA for remote magnetic AF ablation procedures. Methods: All patients eligible for a remote magnetic ablation of AF were included in this study. Ninety patients (70% of the patients were male; age: 60 ± 10 years; CHA2 DS2 -VASC : 1.6 ± 1.2; paroxysmal AF: 60%, persistent AF: 40%), including 45 patients with GA, and 45 patients with LA were enrolled consecutively. Results: There was no significant difference in total procedure time between the two groups (237 ± 50 minutes in the GA group vs 240 ± 61 minutes in the LA group; P = 0.84). Fluoroscopy time was significantly increased in the GA group (14.6 ± 6 minutes vs 11.6 ± 6 minutes, P = 0.018). Ablation time was not different between the two groups (2,320 ± 984 seconds in the GA group vs 2,055 ± 1,023 seconds in the LA group; P = 0.25). After a mean follow-up of 1 year (including repeat procedures), 39/45 patients (86.6%) within the GA group were free from recurrences versus 40/45 patients (88.8%) in the LA group (P = 0.74) without antiarrhythmic drugs. Conclusion: For remote magnetic AF ablation, procedures under LA have similar results to GA in terms of efficacy and safety after 1-year follow-up. (PACE 2015; 38:391–397) remote magnetic navigation, atrial fibrillation, general anesthesia

Introduction Remote magnetic navigation (RMN) is an emerging technique for catheter ablation of supraventricular and ventricular arrhythmias.1,2 Percutaneous radiofrequency (RF) catheter ablation is a validated technique for symptomatic paroxysmal/persistent atrial fibrillation (AF), according to the recent guidelines.3 This procedure can be performed either under general anesthesia (GA), or under local anesthesia (LA)—that is, with mild sedation and analgesia—depending on anesthesiologists’ availability and/or center’s protocol. GA (eventually associated with highfrequency jet ventilation) has shown to be superior to LA for manual AF ablation in terms of arrhythmia recurrence in recent studies.4,5 Several factors may explain this difference, including the occurrence of unexpectedly large breathing movements, which is often challenging during manual

Conflict of Interest: none. Address for reprints: Sok-Sithikun Bun, M.D., Department of Cardiology, Princess Grace Hospital, Pasteur Avenue, Monaco (Principality). Fax: 37797989732; e-mail: [email protected] Received May 27, 2014; revised August 18, 2014; accepted September 14, 2014. doi: 10.1111/pace.12533

RF ablation under conscious sedation. Some tools have been developed to overcome these difficulties: new technologies (cryoablation),6 and new software with respiration gating acquisition.7 The properties of the magnetic catheter tip with constant application on the tissue may also minimize the deleterious impact of the deep breaths. We aimed at comparing acute success after GA or LA utilizing RMN for AF RF ablation procedures. Methods Patient Selection Consecutive patients undergoing AF RF ablation under LA and GA with RMN at our center between June 2010 and June 2012 were included in this study. All patients had conventional indications, with symptomatic AF and a failed attempt to maintain sinus rhythm with antiarrhythmic drug (AAD). Exclusion criteria were hyperthyroidism, left atrial thrombus, decompensated heart failure, stroke, myocardial infarction, or gastrointestinal bleeding within 4 weeks prior to the intervention and life-expectancy

General anesthesia is not superior to local anesthesia for remote magnetic ablation of atrial fibrillation.

Remote magnetic navigation is an emerging technology for atrial fibrillation (AF) ablation. General anesthesia (GA) has shown to be superior to local ...
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