Impact of sedation vs. general anaesthesia on percutaneous epicardial access safety and procedural outcomes

Ammar M. Killu, Alan Sugrue, Thomas M. Munger, David O. Hodge, Siva Mulpuru, Christopher J. McLeod, Douglas L Packer, Samuel J Asirvatham, Paul Andrew Friedman

Research output: Contribution to journalArticle

Abstract

Aims Patient movement while under moderate/deep sedation may complicate percutaneous epicardial access (EpiAcc), mapping and ablation. We sought to compare procedural outcomes in patients undergoing EpiAcc under sedation vs. general anaesthesia (GA) for ablation. Methods and results Patients undergoing EpiAcc between January 2004 and July 2014 were included. Safety, procedural, and clinical outcomes were compared between patients undergoing EpiAcc under sedation or GA for ventricular tachycardia or premature ventricular complex ablation. Between January 2004 and July 2014, 170 patients underwent EpiAcc (mean age, 53.2 ± 15.8 years; average ejection fraction, 44.3 ± 15.3%). The majority (122 [72%] patients) were male. GA was used in 69 (40.6%). There was no difference in route of access (more often anterior, 53.0%) or the rate of successful access (96% overall) between groups. Similarly, the site of ablation (endocardial vs. epicardial vs. combined endocardial/epicardial) was similar between groups. Complications were equally seen between groups-the most frequent event/complication was pericardial effusion, occurring in 10.6% of patients. Finally, procedural and clinical success rates between GA and sedation groups were comparable (93 vs. 91% and 44 vs. 51%, respectively, P > 0.05). Conclusions Choice of anaesthesia for EpiAcc does not appear to significantly affect safety and procedural or clinical outcomes. For patients in whom anaesthesia may pose increased risk, it is reasonable to obtain epicardial access under sedation.

Original languageEnglish (US)
Pages (from-to)329-336
Number of pages8
JournalEuropace
Volume20
Issue number2
DOIs
StatePublished - Feb 1 2018

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General Anesthesia
Safety
Anesthesia
Epicardial Mapping
Deep Sedation
Conscious Sedation
Ventricular Premature Complexes
Pericardial Effusion
Ventricular Tachycardia

Keywords

  • Ablation
  • Anaesthesia
  • Epicardial
  • Percutaneous
  • Sedation
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Impact of sedation vs. general anaesthesia on percutaneous epicardial access safety and procedural outcomes. / Killu, Ammar M.; Sugrue, Alan; Munger, Thomas M.; Hodge, David O.; Mulpuru, Siva; McLeod, Christopher J.; Packer, Douglas L; Asirvatham, Samuel J; Friedman, Paul Andrew.

In: Europace, Vol. 20, No. 2, 01.02.2018, p. 329-336.

Research output: Contribution to journalArticle

Killu, Ammar M. ; Sugrue, Alan ; Munger, Thomas M. ; Hodge, David O. ; Mulpuru, Siva ; McLeod, Christopher J. ; Packer, Douglas L ; Asirvatham, Samuel J ; Friedman, Paul Andrew. / Impact of sedation vs. general anaesthesia on percutaneous epicardial access safety and procedural outcomes. In: Europace. 2018 ; Vol. 20, No. 2. pp. 329-336.
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abstract = "Aims Patient movement while under moderate/deep sedation may complicate percutaneous epicardial access (EpiAcc), mapping and ablation. We sought to compare procedural outcomes in patients undergoing EpiAcc under sedation vs. general anaesthesia (GA) for ablation. Methods and results Patients undergoing EpiAcc between January 2004 and July 2014 were included. Safety, procedural, and clinical outcomes were compared between patients undergoing EpiAcc under sedation or GA for ventricular tachycardia or premature ventricular complex ablation. Between January 2004 and July 2014, 170 patients underwent EpiAcc (mean age, 53.2 ± 15.8 years; average ejection fraction, 44.3 ± 15.3{\%}). The majority (122 [72{\%}] patients) were male. GA was used in 69 (40.6{\%}). There was no difference in route of access (more often anterior, 53.0{\%}) or the rate of successful access (96{\%} overall) between groups. Similarly, the site of ablation (endocardial vs. epicardial vs. combined endocardial/epicardial) was similar between groups. Complications were equally seen between groups-the most frequent event/complication was pericardial effusion, occurring in 10.6{\%} of patients. Finally, procedural and clinical success rates between GA and sedation groups were comparable (93 vs. 91{\%} and 44 vs. 51{\%}, respectively, P > 0.05). Conclusions Choice of anaesthesia for EpiAcc does not appear to significantly affect safety and procedural or clinical outcomes. For patients in whom anaesthesia may pose increased risk, it is reasonable to obtain epicardial access under sedation.",
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AU - Sugrue, Alan

AU - Munger, Thomas M.

AU - Hodge, David O.

AU - Mulpuru, Siva

AU - McLeod, Christopher J.

AU - Packer, Douglas L

AU - Asirvatham, Samuel J

AU - Friedman, Paul Andrew

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N2 - Aims Patient movement while under moderate/deep sedation may complicate percutaneous epicardial access (EpiAcc), mapping and ablation. We sought to compare procedural outcomes in patients undergoing EpiAcc under sedation vs. general anaesthesia (GA) for ablation. Methods and results Patients undergoing EpiAcc between January 2004 and July 2014 were included. Safety, procedural, and clinical outcomes were compared between patients undergoing EpiAcc under sedation or GA for ventricular tachycardia or premature ventricular complex ablation. Between January 2004 and July 2014, 170 patients underwent EpiAcc (mean age, 53.2 ± 15.8 years; average ejection fraction, 44.3 ± 15.3%). The majority (122 [72%] patients) were male. GA was used in 69 (40.6%). There was no difference in route of access (more often anterior, 53.0%) or the rate of successful access (96% overall) between groups. Similarly, the site of ablation (endocardial vs. epicardial vs. combined endocardial/epicardial) was similar between groups. Complications were equally seen between groups-the most frequent event/complication was pericardial effusion, occurring in 10.6% of patients. Finally, procedural and clinical success rates between GA and sedation groups were comparable (93 vs. 91% and 44 vs. 51%, respectively, P > 0.05). Conclusions Choice of anaesthesia for EpiAcc does not appear to significantly affect safety and procedural or clinical outcomes. For patients in whom anaesthesia may pose increased risk, it is reasonable to obtain epicardial access under sedation.

AB - Aims Patient movement while under moderate/deep sedation may complicate percutaneous epicardial access (EpiAcc), mapping and ablation. We sought to compare procedural outcomes in patients undergoing EpiAcc under sedation vs. general anaesthesia (GA) for ablation. Methods and results Patients undergoing EpiAcc between January 2004 and July 2014 were included. Safety, procedural, and clinical outcomes were compared between patients undergoing EpiAcc under sedation or GA for ventricular tachycardia or premature ventricular complex ablation. Between January 2004 and July 2014, 170 patients underwent EpiAcc (mean age, 53.2 ± 15.8 years; average ejection fraction, 44.3 ± 15.3%). The majority (122 [72%] patients) were male. GA was used in 69 (40.6%). There was no difference in route of access (more often anterior, 53.0%) or the rate of successful access (96% overall) between groups. Similarly, the site of ablation (endocardial vs. epicardial vs. combined endocardial/epicardial) was similar between groups. Complications were equally seen between groups-the most frequent event/complication was pericardial effusion, occurring in 10.6% of patients. Finally, procedural and clinical success rates between GA and sedation groups were comparable (93 vs. 91% and 44 vs. 51%, respectively, P > 0.05). Conclusions Choice of anaesthesia for EpiAcc does not appear to significantly affect safety and procedural or clinical outcomes. For patients in whom anaesthesia may pose increased risk, it is reasonable to obtain epicardial access under sedation.

KW - Ablation

KW - Anaesthesia

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KW - Percutaneous

KW - Sedation

KW - Ventricular tachycardia

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