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Electrophysiological effects of desflurane in children with Wolff-Parkinson-White syndrome: a randomized crossover
1Department of Anesthesiology, Osaka City General Hospital, Osaka, Japan.
Insights
Desflurane, an anesthetic, prolonged the effective refractory period of accessory pathways in children undergoing radiofrequency ablation for Wolff-Parkinson-White syndrome, making it unsuitable for this procedure.
Area of Science:
- Anesthesiology
- Pediatric Cardiology
- Electrophysiology
Background:
- Wolff-Parkinson-White (WPW) syndrome involves accessory pathways causing arrhythmias.
- Radiofrequency catheter ablation is a common treatment for WPW syndrome.
- The choice of anesthetic can impact electrophysiological parameters during ablation.
Purpose of the Study:
- To compare the effect of desflurane versus propofol on the antegrade accessory pathway effective refractory period (APERP) in children with WPW syndrome.
- To evaluate desflurane's suitability as an anesthetic during radiofrequency catheter ablation for WPW syndrome in pediatric patients.
Main Methods:
- A randomized crossover study involving children aged 4.1-16.1 years undergoing radiofrequency catheter ablation for WPW syndrome.
- Patients received either desflurane (0.5 or 1.0 MAC) or propofol during electrophysiological studies (EPS) in a crossover design.
- APERP, sinoatrial conduction time, atrio-His interval, and atrioventricular node effective refractory period were measured.
Main Results:
- Desflurane at 1.0 MAC significantly prolonged the APERP compared to propofol.
- Desflurane did not affect sinoatrial conduction time, atrio-His interval, or atrioventricular node effective refractory period.
- Supraventricular tachycardia induction rates were lower with desflurane compared to propofol.
Conclusions:
- Desflurane enhances refractoriness and may impede electrical conduction in atrioventricular accessory pathways.
- Desflurane is not recommended for pediatric patients undergoing radiofrequency catheter ablation for WPW syndrome.
- Further research may explore alternative anesthetic agents for this patient population.
Background:
We hypothesized that, compared with propofol, desflurane prolongs the antegrade accessory pathway effective refractory period (APERP) in children undergoing radiofrequency catheter ablation for Wolff-Parkinson-White (WPW) syndrome.
Methods:
In this randomized crossover study, children aged 4.1-16.1 years undergoing radiofrequency catheter ablation for WPW syndrome were randomly divided into four groups according to the concentration of desflurane and anesthetics used in the first and the second electrophysiological studies (EPS). After induction of general anesthesia with propofol and tracheal intubation, they received one of the following regimens: 0.5 minimum alveolar concentration (MAC) desflurane (first EPS) and propofol (second EPS) (Des0.5-Prop group, n = 8); propofol (first EPS) and 0.5 MAC desflurane (second EPS) (Prop-Des0.5 group, n = 9); 1 MAC desflurane (first EPS) and propofol (second EPS) (Des1.0-Prop group, n = 10); propofol (first EPS) and 1 MAC desflurane (second EPS) (Prop-Des1.0 group, n = 9). Radiofrequency catheter ablation was performed upon completion of EPS. Sample size was determined to detect a difference in the APERP.
Results:
Desflurane at 1.0 MAC significantly prolonged the APERP compared with propofol, but did not affect the sinoatrial conduction time, atrio-His interval or atrioventricular node effective refractory period. Supraventricular tachycardia was induced in all children receiving propofol, but not induced in 1 and 4 children receiving 0.5 MAC and 1.0 MAC desflurane, respectively.
Conclusion:
Desflurane enhances the refractoriness and may block the electrical conduction of the atrioventricular accessory pathway, and is therefore not suitable for use in children undergoing radiofrequency catheter ablation for WPW syndrome.
