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Rajagopalan B, Lakkireddy D, Al-Ahmad A, Chrispin J, Cohen M, Di Biase L, Gopinathannair R, Nasr V, Navara R, Patel P, Santangeli P, Shah R, Sotomonte J, Sridhar A, Tzou W, Cheung JW. Management of anesthesia for procedures in the cardiac electrophysiology laboratory. Heart Rhythm 2024:S1547-5271(24)02822-4. [PMID: 38942104 DOI: 10.1016/j.hrthm.2024.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/16/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
The complexity of cardiac electrophysiology procedures has increased significantly during the past 3 decades. Anesthesia requirements of these procedures can differ on the basis of patient- and procedure-specific factors. This manuscript outlines various anesthesia strategies for cardiac implantable electronic devices and electrophysiology procedures, including preprocedural, procedural, and postprocedural management. A team-based approach with collaboration between cardiac electrophysiologists and anesthesiologists is required with careful preprocedural and intraprocedural planning. Given the recent advances in electrophysiology, there is a need for specialized cardiac electrophysiology anesthesia care to improve the efficacy and safety of the procedures.
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Affiliation(s)
| | | | | | - Jonathan Chrispin
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mitchell Cohen
- Division of Cardiology, Inova Children's Hospital, Fairfax, Virginia
| | - Luigi Di Biase
- Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | | | - Viviane Nasr
- Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts
| | - Rachita Navara
- Department of Medicine, University of California, San Francisco, California
| | - Parin Patel
- Ascension St Vincent's Hospital, Indianapolis, Indiana
| | | | - Ronak Shah
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Wendy Tzou
- Department of Medicine, University of Colorado, Denver, Colorado
| | - Jim W Cheung
- Department of Medicine, Weill Cornell Medicine/NewYork-Presbyterian, New York, New York
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Monaco F, D'Andria Ursoleo J, Lerose CC, Barucco G, Licheri M, Della Bella PE, Fioravanti F, Gulletta S. Anaesthetic management of paediatric patients undergoing electrophysiology study and ablation for supraventricular tachycardia: A focused narrative review. J Clin Anesth 2024; 93:111361. [PMID: 38118231 DOI: 10.1016/j.jclinane.2023.111361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 12/22/2023]
Abstract
Every year, 80,000-100,000 ablation procedures take place in the United States and approximately 1% of these involve paediatric patients. As the paediatric population undergoing catheter ablation to treat dysrhythmia is constantly growing, involvement of anaesthesiologists in the cardiac electrophysiology laboratory is simultaneously increasing. Compared with the adult population, paediatric patients need deeper sedation or general anaesthesia (GA) to guarantee motionlessness and preserve comfort. As a result, the anaesthesiologist working in this setting should keep in mind heart physiopathology as well as possible interactions between anaesthetic drugs and arrhythmia. In fact, drug-induced suppression of accessory pathways (APs) conduction capacity is a major concern for completing a successful electrophysiology study (EPS). Nevertheless, the literature on this topic is scarce and the optimal type of anaesthesia in EPS and ablation procedures in children is still controversial. Thus, the main goal of the present review is to collect the literature published so far on the effects on cardiac conduction tissue of the drugs commonly employed for sedation/GA in the cath lab for EPS and ablation procedures to treat supraventricular tachycardia in patients aged <18 years.
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Affiliation(s)
- Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Jacopo D'Andria Ursoleo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Gaia Barucco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Licheri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Emilio Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Fioravanti
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Gulletta
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Greyling A, Vlachou C, Ailoaei S, Buchholz T, Toth B, Ernst S. Catheter mapping and ablation during pregnancy. Herzschrittmacherther Elektrophysiol 2021; 32:164-173. [PMID: 33782753 DOI: 10.1007/s00399-021-00756-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
A substantial number of pregnant women at some point experience cardiac arrhythmia, which is mostly treated by antiarrhythmic medication. In some instances, arrhythmias can be drug-resistant and pose a relevant risk to both mother and unborn child as they can result in hemodynamic compromise. In recent years, invasive electrophysiology procedures have been carried out with ever reducing exposure to ionising radiation, and multiple techniques have been established to achieve ZERO exposure. Of course, these techniques should all be applied when contemplating an invasive mapping and ablation procedure during pregnancy. The role of the cardio-obstetrics team in planning and performing such procedures is paramount. Careful assessment of the pregnant mother and her unborn child is mandatory. Only with good preparation is a complete understanding of both cardiac anatomy and physiology achievable, which is a pre-requisite of a successful ablation outcome. Various aspects of the ablation procedure itself are discussed and evaluated from the perspective of all team members involved, including the obstetrician, the anaesthetist and the electrophysiologist. This review aims to inform the reader about the techniques available and reports on the published outcomes for ablations during pregnancy in the last decade.
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Affiliation(s)
- Adele Greyling
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton and Harefield Hospital, Sydney Street, SW3 6NP, London, UK
- Department of Paediatric Cardiology, University of Stellenbosch, Cape Town, South Africa
| | - Caterina Vlachou
- Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Stefan Ailoaei
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton and Harefield Hospital, Sydney Street, SW3 6NP, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Bettina Toth
- Universitätsklinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Department Frauenheilkunde, Medizinische Universitaet Innsbruck, Innsbruck, Austria
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton and Harefield Hospital, Sydney Street, SW3 6NP, London, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
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Infraclavicular Brachial Plexus Block and Sugammadex Use in a Paediatric Patient with Wolff-Parkinson--White Syndrome. Rom J Anaesth Intensive Care 2020; 27:19-22. [PMID: 34056120 PMCID: PMC8158309 DOI: 10.2478/rjaic-2020-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Wolff–Parkinson–White (WPW) syndrome is a rare disease that can cause various patterns of tachyarrhythmias. The main goal of anaesthesiologists for the perioperative anaesthetic management of WPW patients must be to avoid sympathetic stimulation and prevent tachyarrhythmias. Case A 9-year-old male patient with a diagnosis of WPW syndrome, who underwent emergency surgery for supracondylar humerus fracture, is presented. General anaesthesia in combination with infraclavicular brachial plexus (ICBP) block was performed successfully without any complications. For the reversal of neuromuscular block, sugammadex was uneventfully used. Intraoperative sympathetic discharge due to surgical intervention was prevented with ICBP block. The ICBP block has also provided good postoperative analgesia. Conclusions Sugammadex is a good alternative for the reversal of neuromuscular blocks to avoid the undesirable effects of cholinergic drugs. Peripheral regional blocks that require relatively large doses of local anaesthetics can be safely performed with utmost attention in paediatric WPW patients.
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