No Differences in General Anesthesia vs. Monitored Anesthesia Care in Pediatric EP Patients, NCDR Study Shows

Among pediatric patients undergoing electrophysiology (EP) procedures, there may be no differences between general anesthesia (GA) and monitored anesthesia care (MAC) in supraventricular tachycardia or ectopic atrial tachycardia inducibility, acute ablation success, or major adverse events, according to a study published June 17 in Circulation: Arrhythmia and Electrophysiology.

Christopher M. Janson, MD, et al., performed a multicenter study using data from ACC's IMPACT Registry to compare the effects of GA vs. MAC in patients ages 1 to 21 undergoing first-time EP studies for evaluation of arrhythmia and arrhythmia history that included supraventricular tachycardia, AV node reentry tachycardia, AV reentrant tachycardia, ectopic atrial tachycardia, premature ventricular contractions or ventricular tachycardia. The researchers excluded cases of congenital heart disease, cardiomyopathy and Wolff-Parkinson-White.

Out of the 6,621 patients in the study, GA was used in 5,913 (89%) and MAC was used in 708 (11%). The primary outcome – a negative EP study, defined as failure to induce clinical tachyarrhythmia – occurred in 9% of all cases, but no differences based on anesthesia strategy (9% GA vs. 10% MAC). Similarly, there were no differences found in supraventricular tachycardia and ectopic atrial tachycardia. In premature ventricular contractions/ventricular tachycardia, patients who underwent GA had a higher rate of negative EP study (28%) vs. MAC (16%) and a higher rate of nonablation (34% GA vs. 14% MAC).

Regarding secondary outcomes, ablation success was high overall and adverse events were rare, with no differences based on anesthesia type for either outcome.

"The primary finding of the study is that while anesthesia strategy is not associated with inducibility of supraventricular tachycardia or ectopic atrial tachycardia, GA is associated with higher rates of non-inducibility in pediatric premature ventricular contractions/ventricular tachycardia cases, when compared with MAC," the authors conclude. "Future studies should evaluate the impact of anesthesia strategy on long-term ablation success, patient experience and cost, as these are additional factors to consider."

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Quality Improvement

Keywords: Child, Infant, Child, Preschool, Adolescent, Young Adult, Tachycardia, Ectopic Atrial, Ventricular Premature Complexes, Atrioventricular Node, Parkinson Disease, Tachycardia, Supraventricular, Tachycardia, Ventricular, Heart Defects, Congenital, Anesthesia, General, Cardiomyopathies, Registries, National Cardiovascular Data Registries, Electrophysiology, IMPACT Registry

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