General Anesthesia With ETT vs LMA in Patients Undergoing Ablation for Atrial Fibrillation

In recent years it has been shown that catheter ablation of symptomatic atrial fibrillation
(PAF) is superior to antiarrhythmic drug therapy with regards to effectiveness and clinical
outcomes. Atrial fibrillation is the most common cardiac arrhythmia, with high rates of
concomitant heart failure, stroke and mortality. During an ablation procedure, a patient can
be managed with intravenous sedation or General Anesthesia (GA). Within this setting, General
anesthesia is associated with improved procedure time and cure rate compared to sedation.

Airway management during GA can be achieved through a laryngeal mask airway (LMA) or an
endotracheal tube (ETT). The use of LMA compared to ETT has been shown in different surgical
populations to decrease procedure and recovery time, improve hemodynamic stability and reduce
anesthetic requirements. It has also shown to decrease airway complications, and
postoperative nausea/vomiting which are important factors that affect overall patient
satisfaction.

Although general anesthesia in electrophysiology procedures is associated with a higher cure
rate, there have been reports of increased airway trauma.Additionally, it is believed that
volatile anesthetics may be associated with increased ventricular action potential duration
as well as prolonged QT interval. The increased usage of opioids during general anesthesia is
also thought to interfere with electrophysiology studies by affecting vagal tone.

At Virginia Commonwelath University (VCU) Health system, Anesthesiologists have been
successfully using LMA (General Anesthesia) for ablation in PAF in eligible patients for over
five years. The investigators plan to perform a retrospective review of all patients who
underwent catheter ablation of PAF at Virginia Commonwealth University Health System from
January 2014 - December 2015. The primary endpoint evaluated will be procedure time. Other
data collected will include demographics, cardiac history, type of anesthesia, amount of
intra-procedure opioids, time to discharge from post anesthesia care unit (PACU), total
length of hospital stay, intra-procedure hemodynamics, intra-procedure
ionotrope/chronotrope/pressor requirements. and atrial fibrillation recurrence at a 3 month
follow-up.