Methods of anesthesiological support in the electrophysiological laboratory
https://doi.org/10.35336/VA-1487
Abstract
The article presents modern methods of anesthetic aids used in the case of such interventional and surgical interventions as implantation of a pacemaker, cardiac resynchronization therapy, cardioverter defibrillator and catheter ablation. The advantages, disadvantages and problematic issues of anesthesia are discussed depending on the type of intervention and the patient’s condition. Based on the analyzed data, it is concluded that anesthesia during interventions in patients with arrhythmological profile is a global practice and emphasizes the positive impact of anesthesia methods on the quality and safety of procedures performed.
About the Authors
V. I. Steklov
Central Military Clinical Hospital named after P.V. Mandrykа of the Ministry of Defense of the Russia
Russian Federation
Russian Federation
Steklov Vladimir
Moscow, 8a Bolshaya Olenya str.
E. A. Kim
Central Military Clinical Hospital named after P.V. Mandrykа of the Ministry of Defense of the Russia
Russian Federation
Russian Federation
Moscow, 8a Bolshaya Olenya str.
M. V. Emelianenko
Clinical City Hospital named after M.P. Konchalovsky
Russian Federation
Russian Federation
Moscow, Zelenograd, 2 Kashtanovaya str.
S. O. Lependin
Central Military Clinical Hospital named after P.V. Mandrykа of the Ministry of Defense of the Russia
Russian Federation
Russian Federation
Moscow, 8a Bolshaya Olenya str.
F. G. Rzaev
Clinical City Hospital named after I.V. Davydovsky
Russian Federation
Russian Federation
Moscow, 11 Yauzskaya str.
References
1. Bokeria LA, Revishvili ASh. Interventsionnaya i khirurgicheskaya aritmologiya: sovremennoe sostoyanie, problemy i perspektivy razvitiya. Meditsinskaya tekhnika. 2002;6: 7-8. (In Russ.)
2. Palmisano P, Ziacchi M, Angeletti A, et al. The Practice of Deep Sedation in Electrophysiology and Cardiac Pacing Laboratories: Results of an Italian Survey Promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing). J Clin Med. 2021;10(21): 5035. https://doi.org/10.3390/jcm10215035.
3. Potievskaya VI, Zabolotskikh IB, Gridchik IE, et al. Sedation of patients in intensive care units. Guidelines. Russian Journal of Anesthesiology and Reanimatology. 2023;(5): 624. (In Russ.). https://doi.org/10.17116/anaesthesiology20230516.
4. Lü F, Lin J, Benditt DG. Conscious sedation and anesthesia in the cardiac electrophysiology laboratory. J Cardiovasc Electrophysiol. 2013;24(2): 237-245. https://doi.org/10.1111/jce.12001.
5. Essandoh MK, Mark GE, Aasbo JD, et al. Anesthesia for subcutaneous implantable cardioverter-defibrillator implantation: Perspectives from the clinical experience of a U.S. panel of physicians. Pacing Clin Electrophysiol.2018;41(7): 807-816. https://doi.org/10.1111/pace.13364.
6. Anesthesiology: national guidelines: a short edition / edited by A.A. Bunyatyan, V.M. Mizikov. Moscow: GEOTAR-Media, 2020. 656 p. (In Russ.). ISBN 978-5-9704-5709-2.
7. Walsh TS, Kydonaki K, Antonelli J, et al. Staff education, regular sedation and analgesia quality feedback, and a sedation monitoring technology for improving sedation and analgesia quality for critically ill, mechanically ventilated patients: a cluster randomised trial. Lancet Respir Med. 2016;4(10):807-817. https://doi.org/10.1016/S2213-2600(16)30178-3.
8. Kozlov IA. Modern approaches to sedation in intensive care units. Meditsinskij alfavit. 2013;1(38): 2232. (In Russ.)
9. Fitzpatrick AP, Lesh MD, Epstein LM, et al. Electrophysiological laboratory, electrophysiologist-implanted, nonthoracotomy-implantable cardioverter/defibrillators. Circulation. 1994;89(6): 2503-2508. https://doi.org/10.1161/01.cir.89.6.2503.
10. Zhang Y, Min J, Chen S. Analgesic Efficacy of Regional Anesthesia of the Hemithorax in Patients Undergoing Subcutaneous Implantable Cardioverter-Defibrillator Placement. J Cardiothorac Vasc Anesth. 2021;35(11): 3288-3293. https://doi.org/10.1053/j.jvca.2021.02.052.
11. Szamborski M, Janc J, Leśnik P, et al. Ultrasound-Guided Pectoserratus Plane Block and Superficial Serratus Anterior Plane Block for Subcutaneous Implantable Cardioverter-Defibrillator Implantation: A Comparative Study. Med Sci Monit. 2023;29: e940541. Published 2023 Jul 21. https://doi.org/10.12659/MSM.940541.
12. Uran C, Giojelli A, Borgogna DA, et al. Ultrasound-guided serratus anterior plane block combined with parasternal block in subcutaneous implantable cardioverter defibrillator implantation: Results of a pilot study. Pacing Clin Electrophysiol. 2020;43(7): 705-712. https://doi.org/10.1111/pace.13944.
13. Ziacchi M, Bisignani G, Palmisano P, et al. Serratus anterior plane block in subcutaneous implantable cardioverter defibrillator implantation: A case-control analysis. J Cardiovasc Electrophysiol. 2019;31: 144-149. https://doi.org/10.1111/jce.14293.
14. Sumin SA. Midazolam: opportunities and prospects for use in intensive care. Medical alphabet. 2017;3(29): 47-52. (In Russ.).
15. Miśkowiec D, Kasprzak JD, Wejner-Mik P, et al. Conscious sedation during cryoballoon ablation of atrial fibrillation: a feasibility and safety study. Minerva Cardioangiol. 2018;66(2): 143-151. https://doi.org/10.23736/S0026-4725.17.04505-4
16. Fox DJ, Davidson NC, Bennett DH, et al. Safety and acceptability of implantation of internal cardioverter-defibrillators under local anesthetic and conscious sedation. Pacing Clin Electrophysiol. 2007;30: 992-997. https://doi.org/10.1111/j.1540-8159.2007.00816.x.
17. Marquié C, Duchemin A, Klug D, et al. Can we implant cardioverter defibrillator under minimal sedation?. Europace. 2007;9(7): 545-550. https://doi.org/10.1093/europace/eum060.
18. Kaya E, Südkamp H, Lortz J, et al. Feasibility and safety of using local anaesthesia with conscious sedation during complex cardiac implantable electronic device procedures. Sci Rep. 2018;8(1): 7103. https://doi.org/10.1038/s41598-018-25457-x.
19. Trouvé-Buisson T, Arvieux L, Bedague D, et al. Anaesthesiological support in a cardiac electrophysiology laboratory: a single-centre prospective observational study. Eur J Anaesthesiol. 2013 Nov;30(11): 658-63. https://doi.org/10.1097/EJA.0b013e3283626095.
20. Pandya K, Patel MB, Natla J, et al. Predictors of hemodynamic compromise with propofol during defibrillator implantation: a single center experience. J Interv Card Electrophysiol. 2009;25(2): 145-151. https://doi.org/10.1007/s10840-008-9355-6.
21. Shatalov KV, Serguladze SY, Abdurazakov MA, et al. Cardiac resynchronization therapy: alternative methods of left ventricular electrode implantation. Minimally Invasive Cardiovascular Surgery. 2024;3(3): 39-49. (In Russ.).
22. Pfau G, Schilling T, Kozian A, et al. Outcome after implantation of cardiac resynchronization/defibrillation systems in patients with congestive heart failure and left bundle-branch block. J Cardiothorac Vasc Anesth. 2010;24(1): 30-36. https://doi.org/10.1053/j.jvca.2009.07.009
23. Theron P, Guha K, Mantziari L, et al. General anesthesia versus sedation for implantation of a biventricular pacing device for cardiac resynchronization therapy. J Cardiothorac Vasc Anesth. 2014;28: 280-284. https://doi.org/10.1053/j.jvca.2013.07.008.
24. Looi KL, Lee AS, Cole K, et al. Conscious sedation and analgesia use in cardiac device implantation. Int J Cardiol. 2013;168(1): 561-563. https://doi.org/10.1016/j.ijcard.2013.01.167.
25. Ladeev AYu, Marochkov AV, Dmitrieva VN. The history of the creation and development of implantable cardioverter defibrillators. Surgery news. 2016;24(4): 317-327. (In Russ) https://doi.org/10.18484/2305-0047.2016.4.317.
26. Sayfo S, Vakil KP, Alqaqa’a A, et al. A retrospective analysis of proceduralist-directed, nurse-administered propofol sedation for implantable cardioverter-defibrillator procedures. Heart Rhythm. 2012;9(3): 342-346. https://doi.org/10.1016/j.hrthm.2011.10.009.
27. Cappato R, Smith WM, Hood MA, et al. Subcutaneous chronic implantable defibrillation systems in humans. J Interv Card Electrophysiol. 2012;34(3): 325-332. https://doi.org/10.1007/s10840-012-9665-6.
28. Burke MC, Gold MR, Knight BP, et al. Safety and Efficacy of the Totally Subcutaneous Implantable Defibrillator: 2-Year Results From a Pooled Analysis of theIDE Study and EFFORTLESS Registry. J Am Coll Cardiol. 2015;65(16): 1605-1615. https://doi.org/10.1016/j.jacc.2015.02.047.
29. Essandoh MK, Portillo JG, Weiss R, et al. Anesthesia care for subcutaneous implantable. J Clin Anesth. 2016;31: 53-59. https://doi.org/10.1016/j.jclinane.2015.11.009.
30. Blomström-Lundqvist C, Gizurarson S, Schwieler J, et al. Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial. JAMA. 2019;321(11): 1059-1068. https://doi.org/10.1001/jama.2019.0335.
31. Hoffmann E, Straube F, Wegscheider K, et al. Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation. Europace. 2019;21(9): 1313-1324. https://doi.org/10.1093/europace/euz155.
32. Di Biase L, Conti S, Mohanty P, et al. General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study. Heart Rhythm. 2011;8(3): 368-372. https://doi.org/10.1016/j.hrthm.2010.10.043.
33. Stašková K, Bulava A, Tesařík R, et al. Radiofrequency catheter ablation of atrial fibrillation performed under general anesthesia: results of a unicentric randomized trial. Vnitr Lek. 2017;63(3): 163-169.
34. Firme EB, Cavalcanti IL, Barrucand L, et.al. Curative ablation of atrial fibrillation: comparison between deep sedation and general anesthesia. Rev Col Bras Cir. 2012;39(6): 462-468. https://doi.org/10.1590/s0100-69912012000600004.
35. Li Ka Hou C, Sang T, Chan C, et al. Anesthesia use in catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies. Heart Asia. 2019;11(2): e011155. https://doi.org/10.1136/heartasia-2018-011155.
36. Gerstein NS, Young A, Schulman PM, et al. Sedation in the Electrophysiology Laboratory: A Multidisciplinary Review. J Am Heart Assoc. 2016;5(6): e003629. https://doi.org/10.1161/JAHA.116.003629.
37. Goode JS Jr, Taylor RL, Buffington CW, et al. High-frequency jet ventilation: utility in posterior left atrial catheter ablation. Heart Rhythm. 2006;3(1): 13-19. https://doi.org/10.1016/j.hrthm.2005.09.013.
38. Kottkamp H, Hindricks G, Eitel C, et al. Deep sedation for catheter ablation of atrial fibrillation: a prospective study in 650 consecutive patients. J Cardiovasc Electrophysiol. 2011;22(12): 1339-1343. https://doi.org/10.1111/j.1540-8167.2011.02120.x.
39. Liu Q, Kong AL, Chen R, et al. Propofol and arrhythmias: two sides of the coin. Acta Pharmacol Sin. 2011 Jun;32(6): 817-23. https://doi.org/10.1038/aps.2011.42
40. Vevecka A, Schwab C, Forkmann M, et al. Predictive Factors and safety of noninvasive mechanical ventilation in combination with propofol deep sedation in left atrial ablation procedures. Am J Cardiol. 2019;124(2): 233-238. https://doi.org/10.1016/j.amjcard.2019.04.013.
41. Sairaku A, Yoshida Y, Hirayama H, et al. Procedural sedation with dexmedetomidine during ablation of atrial fibrillation: a randomized controlled trial. Europace. 2014;16(7): 994-999. https://doi.org/10.1093/europace/eut363.
42. Cho JS, Shim JK, Na S, et al. Improved sedation with dexmedetomidine-remifentanil compared with midazolam-remifentanil during catheter ablation of atrial fibrillation: a randomized, controlled trial. Europace. 2014;16(7): 1000-6. https://doi.org/10.1093/europace/eut365.
43. Pang N, Gao J, Zhang N, et al. Comparison of the Different Anesthesia Strategies for Atrial Fibrillation Catheter Ablation: A Systematic Review and Meta-Analysis. Cardiol Res Pract. 2022;2022: 1124372. https://doi.org/10.1155/2022/1124372.
44. Yildiz M, Yilmaz Ak H, Oksen D, et al. Anesthetic Management In Electrophysiology Laboratory: A Multidisciplinary Review. J Atr Fibrillation. 2018;10(5):1775. https://doi.org/10.4022/jafib.1775.
45. Nelson EW, Woltz EM, Wolf BJ, et al. A Survey of Current Anesthesia Trends for Electrophysiology Procedures. Anesth Analg. 2018;127(1): 46-53. https://doi.org/10.1213/ANE.0000000000003376.
46. Kovoor P, Porter R, Uther JB, Ross DL. Efficacy and safety of a new protocol for continuous infusion of midazolam and fentanyl and its effects on patient distress during electrophysiological studies. Pacing Clin Electrophysiol. 1997;20(11): 2765-2774. https://doi.org/10.1111/j.1540-8159.1997.tb05434.x
47. Khan ZP, Ferguson CN, Jones RM. alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia. 1999;54(2): 146-165. https://doi.org/10.1046/j.1365-2044.1999.00659.x
48. Terao Y, Higashijima U, Toyoda T, et al. The effects of intravenous anesthetics on QT interval during anesthetic induction with sevoflurane. J Anesth. 2016;30(6): 929-934. https://doi.org/10.1007/s00540-016-2252-8.
49. Zhong Q, Kumar A, Deshmukh A, Bennett C. Dexmedetomidine Reduces Incidences of Ventricular Arrhythmias in Adult Patients: A Meta-Analysis. Cardiol Res Pract. 2022;2022: 5158362. https://doi.org/10.1155/2022/5158362.
50. Shannon K, Saltzman D, Li I, et al. Ventricular tachycardia converts to sinus rhythm after administration of propofol. Am J Emerg Med. 2021;48: 377.e1-377.e3. https://doi.org/10.1016/j.ajem.2021.04.028.
51. Patel S, Deng J, Zubair A, et al. Sedation Versus General Anesthesia for Ablation of Ventricular Arrhythmias: A Systematic Review and Meta-Analysis. Ann Card Anaesth. 2025;28(2):119-127. https://doi.org/10.4103/aca.aca_229_24.
52. Polovinka VS, Demyanenko AV, Steklov VI, et al. Innovative methods of treatment of ventricular arrhythmias of the heart. Military Medical Journal. 2014;335(11): 44-52. (In Russ). https://doi.org/10.17816/RMMJ74301.
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For citations:
Steklov V.I., Kim E.A., Emelianenko M.V., Lependin S.O., Rzaev F.G. Methods of anesthesiological support in the electrophysiological laboratory. Journal of Arrhythmology. 2025;32(3):64-72. (In Russ.) https://doi.org/10.35336/VA-1487
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