Comparison of Outcomes of Pediatric Catheter Ablation by Anesthesia Strategy: A Report from the NCDR IMPACT Registry.
Year of Publication
2021 Jun 17
<p>- Anesthesia strategies for pediatric ablation procedures include general anesthesia (GA) and monitored anesthesia care (MAC). The effects of anesthesia strategy on arrhythmia inducibility and procedural outcomes have not been investigated. - A multicenter retrospective study was performed, utilizing data from the NCDR IMPACT Registry. Data from subjects 1-21 years undergoing elective first-time electrophysiology study (EPS) for evaluation of documented SVT, EAT, or PVC/VT from 4/1/16-12/31/19 were included, excluding cases with WPW, congenital heart disease, and/or cardiomyopathy. The primary outcome was a negative EPS, defined as failure to induce the clinical tachyarrhythmia. Secondary outcomes included ablation success and adverse events (AE). - 6621 subjects from 78 centers were evaluated: 49% male; mean age 13.3±3.8 years. GA was utilized in 5913 (89%), with MAC in 708 (11%). A negative EPS occurred in 9% of cases overall, with no difference by anesthesia strategy (9% GA vs. 10% MAC, p=0.2). In SVT and EAT, there was no significant difference in likelihood of a negative EPS by anesthesia strategy. In PVC/VT, there was a higher rate of negative EPS under GA (28% GA vs. 16% MAC, p=0.02), translating to a higher rate of non-ablation (34% GA vs. 14% MAC, p<0.001). In multivariable models, GA was associated with negative EPS in PVC/VT (OR 2.2, 95% CI 1.1-4.4, p=0.03), but not in SVT or EAT. Acute ablation success was not different between strategies (94% GA vs. 94% MAC, p=0.2). Major AE were rare, with no differences between GA and MAC. - In this first report on pediatric ablation data in IMPACT, there were no differences between GA and MAC in SVT or EAT inducibility, acute ablation success, or major AE. GA was associated with higher rates of non-inducibility and non-ablation in PVC/VT cases. A MAC strategy should be considered for PVC/VT ablation in the pediatric population.</p>
Circ Arrhythm Electrophysiol