General Anesthesia With ETT vs LMA in Patients Undergoing Ablation for Atrial Fibrillation
Condition: Atrial Fibrillation
MeSH terms: Atrial Fibrillation
Study type: Interventional

Summary: 
      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 Commonwealth 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.
    


Intervention name(s): General Anesthesia with endotracheal tube; General Anesthesia with laryngeal mask airway
Intervention type(s): Device; Device
Intervention description(s): Patient randomized to this arm will have general anesthesia with endotracheal tube placed and will be kept at an appropriate depth of anesthesia for patient comfort and procedure needs.; Patients randomized to this arm will have general anesthesia with laryngeal mask airway placed and will be kept at an appropriate depth of anesthesia for patient comfort and procedure needs.
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Health Services Research