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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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Finnerty DT, Griffin M. Recent Developments in Cardiology Procedures for Adult Congenital Heart Disease: The Anesthesiologist's Perspective. J Cardiothorac Vasc Anesth 2020; 35:741-751. [PMID: 32762881 DOI: 10.1053/j.jvca.2020.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 12/17/2022]
Abstract
Many children born today with congenital heart disease can expect to live long into adulthood. Improvements in surgical technique and anesthetic and perioperative care have significantly increased the number of survivors. Unfortunately, as these patients progress through life they frequently require further interventions. Although surgical intervention may be required frequently, these patients can be managed in the cardiac catheterization or electrophysiology laboratory. Surgical correction of tetralogy of Fallot can leave patients with pulmonary valve dysfunction later in life. A percutaneous approach is now available for these patients, which can obviate the need for resternotomy. During deployment of the valve, anesthesiologists should be aware that compression of coronary arteries can occur. Adult congenital heart disease (ACHD) patients often require pacemaker/implantable cardioverter- defibrillator (ICD) insertion or ablation therapy. These patients may have altered cardiac anatomy, which can make endovascular procedures extremely challenging. Recent developments have made these procedures safer and more efficient. A number of congenital cardiac conditions can also be associated with orofacial abnormalities. ACHD patients, as a result, can present with challenging airways. The catheterization laboratory may not be the optimum environment for the anesthesiologist to manage a difficult airway. The requirement of transesophageal echocardiography for some cath eterization procedures needs to be considered when deciding on an airway management plan. Knowledge of the underlying cardiac anatomy and the planned procedure is advised when providing anesthesia for this complex patient group outside the theater setting.
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Affiliation(s)
- Dylan T Finnerty
- Division of Anesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
| | - Michael Griffin
- Division of Anesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
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Zaballos M, Del Blanco B, Sevilla R, De Diego C, Anadon MJ, Jimeno C, Almendral J. Differential effects of sevoflurane and propofol on swine cardiac conduction system. Vet Anaesth Analg 2019; 46:344-351. [PMID: 30833141 DOI: 10.1016/j.vaa.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/05/2018] [Accepted: 11/30/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the effects of sevoflurane and propofol on the porcine cardiac conduction system. STUDY DESIGN A prospective, comparative study of electrophysiological properties of anaesthetics agents in an experimental porcine model. ANIMALS A total of 36 hybrid Landrace-Large White pigs. METHODS After premedication with 20 mg kg-1 of intramuscular ketamine, anaesthesia was induced with 4.5 mg kg-1propofol intravenously. In 18 consecutive animals, anaesthesia was maintained with propofol (13 mg kg-1 hour-1) and in the remaining 18 animals with 2.66% sevoflurane. The femoral artery and vein were canalized for invasive monitoring, analytical blood gas sampling and intracardiac catheter insertion. Following instrumentation and after a period of stabilization, a customary electrophysiological evaluation was performed. We compared the electrophysiology of the sinus and atrioventricular node (AV) node under sevoflurane or propofol anaesthesia, and the effects of both anaesthetics on atrial and ventricular refractoriness. RESULTS There was a significant difference in sinus node recovery time between sevoflurane and propofol (907 ± 231 versus 753 ± 146 ms, p = 0.02). Sevoflurane in comparison with propofol significantly prolonged specialized AV conduction times, represented by an increased Wenckebach cycle length (272 ± 54 versus 235 ± 40 ms, p = 0.03) and AV nodal refractoriness (327 ± 34 versus 287 ± 30 ms, p = 0.002). In addition, sevoflurane prolonged ventricular refractoriness (298 ± 27 versus 255 ± 38 ms, p = 0.007) and the QT corrected interval (0.50 ± 0.05 versus 0.46 ± 0.09 ms, p = 0.005). CONCLUSIONS AND CLINICAL RELEVANCE Sevoflurane in comparison with propofol, depresses several parameters of sinus and AV nodal function and prolongs the ventricular refractoriness of the porcine cardiac conduction system. These findings should be taken into consideration for the choice of anaesthetic agents in clinical and experimental settings.
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Affiliation(s)
- Matilde Zaballos
- Department of Toxicology, Complutense University, Madrid, Spain; Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Brezo Del Blanco
- Department of Anaesthesiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Raul Sevilla
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Carlos De Diego
- Department of Cardiology, Hospital Universitario de Torrevieja, Alicante, Spain
| | - Ma José Anadon
- Department of Toxicology, Complutense University, Madrid, Spain
| | - Concepción Jimeno
- Department of Anaesthesiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Jesús Almendral
- Department of Medicine, CEU San Pablo University, Madrid, Spain; Department of Electrophysiology, Grupo Hospital de Madrid, Madrid, Spain
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Vladinov G, Fermin L, Longini R, Ramos Y, Maratea E. Choosing the anesthetic and sedative drugs for supraventricular tachycardia ablations: A focused review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1555-1563. [DOI: 10.1111/pace.13511] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Greta Vladinov
- School of Nursing and Health Studies; University of Miami Health System; Miami FL USA
| | - Lilibeth Fermin
- Department of Anesthesiology, Miller School of Medicine; University of Miami Health System; Miami FL USA
| | - Renee Longini
- School of Nursing and Health Studies; University of Miami Health System; Miami FL USA
| | - Yanett Ramos
- School of Nursing and Health Studies; University of Miami Health System; Miami FL USA
| | - Edward Maratea
- Department of Anesthesiology, Miller School of Medicine; University of Miami Health System; Miami FL USA
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Fujii S, Zhou JR, Dhir A. Anesthesia for Cardiac Ablation. J Cardiothorac Vasc Anesth 2018; 32:1892-1910. [DOI: 10.1053/j.jvca.2017.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Indexed: 12/19/2022]
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Abstract
The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen. We review a range of electrophysiology procedures and discuss anesthetic approaches that balance patient safety and favorable outcomes.
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Affiliation(s)
- Jeff E Mandel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - William G Stevenson
- Electrophysiology Section, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Deng Y, Naeini PS, Razavi M, Collard CD, Tolpin DA, Anton JM. Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia. Tex Heart Inst J 2016; 43:496-502. [PMID: 28100967 DOI: 10.14503/thij-15-5688] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Radiofrequency catheter ablation is increasingly being used to treat patients who have ventricular tachycardia, and anesthesiologists frequently manage their perioperative care. This narrative review is intended to familiarize anesthesiologists with preprocedural, intraprocedural, and postprocedural implications of this ablation. Ventricular tachycardia typically arises from structural heart disease, most often from scar tissue after myocardial infarction. Many patients thus affected will benefit from radiofrequency catheter ablation in the electrophysiology laboratory to ablate the foci of arrhythmogenesis. The pathophysiology of ventricular tachycardia is complex, as are the technical aspects of mapping and ablating these arrhythmias. Patients often have substantial comorbidities and tenuous hemodynamic status, necessitating pharmacologic and mechanical cardiopulmonary support. General anesthesia and monitored anesthesia care, when used for sedation during ablation, can lead to drug interactions and side effects in the presence of ventricular tachycardia, so anesthesiologists should also be aware of potential perioperative complications. We discuss variables that can help anesthesiologists safely guide patients through the challenges of radiofrequency catheter ablation of ventricular tachycardia.
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Yoshida S, Suzuki T, Yoshida Y, Watanabe S, Nakamura K, Sasaki T, Kawasaki Y, Ehara E, Murakami Y, Kato T, Nakamura Y. Feasibility and safety of transseptal puncture procedures for radiofrequency catheter ablation in small children weighing below 30 kg: single-centre experience. Europace 2015; 18:1581-1586. [PMID: 26705553 DOI: 10.1093/europace/euv383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/26/2015] [Indexed: 12/22/2022] Open
Abstract
AIMS Transseptal puncture (TSP) has become a common approach in catheter ablation of arrhythmia originating from the left atrium. In paediatric patients, however, TSP can be a challenge due to narrower access vessels and small left atrial size, and the safety of TSP in smaller children is yet to be understood. The purpose of this study was to retrospectively evaluate the feasibility and safety of TSP in children weighing below 30 kg. METHODS AND RESULTS Among 655 paediatric patients who underwent catheter ablation of arrhythmia between July 2009 and April 2015, 43 cases having structurally normal hearts, weighing <30 kg and requiring TSP were included in the study. Age, height, body weight, diagnosis, and complications during TSP and catheter ablation were evaluated. The median age, height, and body weight (range) were 7.0 years (0.3-11.1), 116.8 cm (54.0-138.4 cm) and 21.5 kg (4.3-29.6 kg), respectively. Diagnosis included manifest (n = 27; 62.8%) and concealed accessory pathway (n = 14; 32.6%) and atrial tachycardia (n = 2; 4.6%). In 10 cases (23.2%), TSP using radiofrequency energy was performed. None of the patients had major complications. Pericardial effusion was recorded as a minor complication in one patient (2.3%). CONCLUSION TSP was feasible, safe, and of low risk of complications in children weighing <30 kg.
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Affiliation(s)
- Shuichiro Yoshida
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan .,Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Yoko Yoshida
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Shigeo Watanabe
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Kae Nakamura
- Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Takeshi Sasaki
- Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Yuki Kawasaki
- Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Eiji Ehara
- Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Yosuke Murakami
- Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
| | - Taichi Kato
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yoshihide Nakamura
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima- ku, Osaka 534-0021, Japan
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Maxwell BG, Harrington KB, Hill CC, Banayan JM, Spiess BD. CASE 4-2014: ascending aortic pseudoaneurysm repair with deep hypothermic circulatory arrest in an adult congenital heart disease patient with heparin-induced thrombocytopenia. J Cardiothorac Vasc Anesth 2014; 28:810-8. [PMID: 24656300 DOI: 10.1053/j.jvca.2013.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Bryan G Maxwell
- Department of Anesthesiology, Stanford University Medical Center, Stanford, CA.
| | | | - Charles C Hill
- Department of Anesthesiology, Stanford University Medical Center, Stanford, CA
| | - Jennifer M Banayan
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Bruce D Spiess
- Department of Anesthesiology and Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
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Abstract
The array of diagnostic and therapeutic procedures performed in the cardiology electrophysiology laboratory has expanded rapidly. Increasingly more facilities and cardiologists are performing these procedures, and the number of patients for whom these procedures are indicated is expanding. Because of the complexity of the procedures and associated patient comorbidity, anesthesia providers will become more involved in providing care in the electrophysiology laboratory. Therefore, anesthesia providers must be prepared to handle a broad range of case complexity. This article addresses the implications of providing anesthesia safely and effectively in the electrophysiology laboratory.
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Affiliation(s)
- Ryan Anderson
- Division of Adult Cardiothoracic Anesthesia, Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, UHS-2, Portland, OR 97239, USA
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12
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Kwak J. Anesthesia for Electrophysiology Studies and Catheter Ablations. Semin Cardiothorac Vasc Anesth 2012; 17:195-202. [DOI: 10.1177/1089253212469840] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Providing anesthesia in nonoperating room locations is becoming increasingly common. The field of electrophysiology and its patient population are growing, resulting in a greater need for anesthesiologists in the electrophysiology laboratory. The procedures are complex and of long duration with patients who have multiple comorbidities. The electrophysiology laboratory is a unique situation in that arrhythmias are sought and sometimes even provoked so that they may be eliminated. The focus of this review will be on anesthesia for electrophysiology studies and catheter ablation.
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Affiliation(s)
- Jenny Kwak
- Loyola University Medical Center, Maywood, IL, USA
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Hayman M, Forrest P, Kam P. Anesthesia for Interventional Cardiology. J Cardiothorac Vasc Anesth 2012; 26:134-47. [DOI: 10.1053/j.jvca.2011.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Indexed: 01/17/2023]
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