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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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Waldmann V, Amet D, Zhao A, Ladouceur M, Otmani A, Karsenty C, Maltret A, Ollitrault J, Pontnau F, Legendre A, Florens E, Munte L, Soulat G, Mousseaux E, Du Puy-Montbrun L, Lavergne T, Bonnet D, Vouhé P, Jouven X, Marijon E, Iserin L. Catheter ablation in adults with congenital heart disease: A 15-year perspective from a tertiary centre. Arch Cardiovasc Dis 2021; 114:455-464. [PMID: 33846095 DOI: 10.1016/j.acvd.2020.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/08/2020] [Accepted: 12/22/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND With the growing adult congenital heart disease (ACHD) population, the number of catheter ablation procedures is expected to dramatically increase. Data reporting experience and evolution of catheter ablation in patients with ACHD, over a significant period of time, remain scarce. AIM We aimed to describe temporal trends in volume and outcomes of catheter ablation in patients with ACHD. METHODS This was a retrospective observational study including all consecutive patients with ACHD undergoing attempted catheter ablation in a large tertiary referral centre over a 15-year period. Acute procedural success rate and freedom from recurrence at 12 and 24 months were analysed. RESULTS From November 2004 to November 2019, 302 catheter ablations were performed in 221 patients with ACHD (mean age 43.6±15.0 years; 58.9% male sex). The annual number of catheter ablations increased progressively from four to 60 cases per year (P<0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common arrhythmia (n=217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.4% (P<0.001). Use of irrigated catheters (odds ratio [OR] 4.03, 95% confidence interval [CI] 1.86-8.55), a three-dimensional mapping system (OR 3.70, 95% CI 1.72-7.74), contact force catheters (OR 3.60, 95% CI 1.81-7.38) and high-density mapping (OR 3.69, 95% CI 1.82-8.14) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (P=0.001). Seven (2.3%) non-fatal complications occurred. CONCLUSIONS The number of catheter ablation procedures in patients with ACHD has increased considerably over the past 15 years. Growing experience and advances in ablative technologies appear to be associated with a significant improvement in acute and mid-term outcomes.
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Affiliation(s)
- Victor Waldmann
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France; Paediatric and Congenital Heart Disease Department, Necker Hospital, 75015 Paris, France.
| | - Denis Amet
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Alexandre Zhao
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Akli Otmani
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Clement Karsenty
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Alice Maltret
- Paediatric and Congenital Heart Disease Department, Necker Hospital, 75015 Paris, France
| | - Jacky Ollitrault
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Florence Pontnau
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Antoine Legendre
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France; Paediatric and Congenital Heart Disease Department, Necker Hospital, 75015 Paris, France
| | - Emmanuelle Florens
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Laura Munte
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Gilles Soulat
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Elie Mousseaux
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Leonarda Du Puy-Montbrun
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Thomas Lavergne
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Damien Bonnet
- Paediatric and Congenital Heart Disease Department, Necker Hospital, 75015 Paris, France
| | - Pascal Vouhé
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Xavier Jouven
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Eloi Marijon
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France
| | - Laurence Iserin
- Adult Congenital Heart Disease Medico-Surgical Unit, Georges Pompidou European Hospital, 75015 Paris, France; Paediatric and Congenital Heart Disease Department, Necker Hospital, 75015 Paris, France
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