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Published on: May 26, 2015
Catheter ablation for atrial fibrillation can be safely performed without invasive hemodynamic monitoring: A
Arshad Muhammad Iqbal1, Kai Yu Li2, Sam G Aznaurov3
1Department of Cardiology, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO, USA. arshadiqbal9090@gmail.com.
Insights
Non-invasive hemodynamic monitoring is as safe as invasive monitoring for atrial fibrillation ablation. This approach may reduce procedure time and costs, avoiding arterial access complications.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Anesthesiology
Background:
- Arterial invasive monitoring is standard for hemodynamic monitoring during atrial fibrillation (AF) ablation in the USA.
- Limited data exists comparing non-invasive and invasive hemodynamic monitoring in complex cardiac procedures like AF ablation.
- The safety benefits of invasive hemodynamic monitoring in AF ablation are unclear given advancements like intracardiac echocardiography.
Purpose of the Study:
- To determine if non-invasive hemodynamic monitoring is non-inferior to invasive hemodynamic monitoring during AF ablation under general anesthesia.
- To evaluate procedural safety in patients without major cardiac structural abnormalities.
Main Methods:
- A multi-center retrospective analysis of 362 patients undergoing AF ablation from July 2019 to December 2020.
- Patients were divided into two groups: non-invasive hemodynamic monitoring (Group A) and invasive hemodynamic monitoring (Group B).
- The primary outcome was to compare procedural safety between the two groups.
Main Results:
- No significant difference in complication rates (groin hematoma, pericardial effusion, cardiac tamponade) between the non-invasive and invasive groups.
- Mean procedure time was longer in the invasive monitoring group (Group B).
- Arterial site discomfort was reported in 3.35% of the invasive group, with urgent arterial access needed in only one patient in the non-invasive group.
Conclusions:
- Non-invasive hemodynamic monitoring is a safe alternative to invasive monitoring for AF ablation under general anesthesia.
- This approach eliminates the need for arterial access, potentially improving procedural efficiency and reducing costs.
- Further research may support wider adoption of non-invasive methods in complex cardiac procedures.
Background:
Arterial invasive monitoring is the most common method in the USA for hemodynamic monitoring during atrial fibrillation (AF) ablation. Although studies have shown favorable comparison between non-invasive and invasive hemodynamic monitoring (IHM) in non-cardiac procedures under general anesthesia, limited data is available for complex cardiac procedures such as AF ablation in the USA. With progressive improvement in AF ablation procedural safety, particularly with routine use of intracardiac echocardiography (ICE) to monitor for pericardial effusion, it is unclear if invasive hemodynamic monitoring provides any advantage over non-invasive methods. Therefore, the purpose of this study is to determine whether noninvasive hemodynamic monitoring is non-inferior to invasive hemodynamic monitoring during AF ablation under general anesthesia in patients without major cardiac structural abnormality.
Methods:
A multi-center retrospective data of AF ablation from July 2019 to December 2020 was extracted. A total of three hundred and sixty-two patients (362) were included, which were divided into group A (non-invasive hemodynamic monitoring) and group B (invasive hemodynamic monitoring). The primary outcome was to compare procedural safety between the two groups.
Results:
Out of 362 patients, 184 (51%) received non-invasive and 178 (49%) received invasive hemodynamic monitoring with similar baseline characteristics. There was no significant difference between the two groups in complication rates (groin hematoma, pericardial effusion, cardiac tamponade). Mean procedure time was longer in group B with 3.35% arterial site discomfort. Urgent arterial access was required in only 1 patient in group A.
Conclusion:
This retrospective multicenter study strongly suggests that catheter ablation for atrial fibrillation under general anesthesia can be safely performed with noninvasive hemodynamic monitoring without requiring arterial access, with potential benefit in procedural duration and cost.
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