Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Europace. 2018 Feb 1;20(2):329-336. doi: 10.1093/europace/euw313.
Patient movement while under moderate/deep sedation may complicate percutaneous epicardial access (EpiAcc), mapping and ablation. We sought to compare procedural outcomes in patients undergoing EpiAcc under sedation vs. general anaesthesia (GA) for ablation.
Patients undergoing EpiAcc between January 2004 and July 2014 were included. Safety, procedural, and clinical outcomes were compared between patients undergoing EpiAcc under sedation or GA for ventricular tachycardia or premature ventricular complex ablation. Between January 2004 and July 2014, 170 patients underwent EpiAcc (mean age, 53.2 ± 15.8 years; average ejection fraction, 44.3 ± 15.3%). The majority (122 [72%] patients) were male. GA was used in 69 (40.6%). There was no difference in route of access (more often anterior, 53.0%) or the rate of successful access (96% overall) between groups. Similarly, the site of ablation (endocardial vs. epicardial vs. combined endocardial/epicardial) was similar between groups. Complications were equally seen between groups-the most frequent event/complication was pericardial effusion, occurring in 10.6% of patients. Finally, procedural and clinical success rates between GA and sedation groups were comparable (93 vs. 91% and 44 vs. 51%, respectively, P > 0.05).
Choice of anaesthesia for EpiAcc does not appear to significantly affect safety and procedural or clinical outcomes. For patients in whom anaesthesia may pose increased risk, it is reasonable to obtain epicardial access under sedation.
在中度/深度镇静下，患者的移动可能会使经皮心外膜入路（EpiAcc）、标测和消融复杂化。我们旨在比较镇静下和全身麻醉（GA）下行 EpiAcc 用于消融术的患者的手术结果。
纳入 2004 年 1 月至 2014 年 7 月期间接受 EpiAcc 的患者。比较镇静下行 EpiAcc 或 GA 行室性心动过速或室性早搏消融的患者的安全性、手术和临床结果。2004 年 1 月至 2014 年 7 月，共 170 例患者接受 EpiAcc（平均年龄 53.2 ± 15.8 岁；平均射血分数 44.3 ± 15.3%）。大多数患者（122 例[72%]为男性）为男性。69 例（40.6%）患者使用 GA。两组患者的入路途径（更常见的是前入路，53.0%）或成功率（总体成功率为 96%）无差异。同样，消融部位（心内膜 vs. 心外膜 vs. 心内膜/心外膜联合）在两组之间也相似。两组并发症发生率相似，最常见的事件/并发症是心包积液，发生率为 10.6%。最后，GA 组和镇静组的手术成功率和临床成功率相当（分别为 93% vs. 91%和 44% vs. 51%，P > 0.05）。
EpiAcc 麻醉方式的选择似乎不会显著影响安全性以及手术或临床结果。对于麻醉风险增加的患者，在镇静下获得心外膜入路是合理的。
