Anaesthesia for electrophysiology procedures in the cardiac catheter laboratory

Abstract

There has been an exponential increase in catheter ablation procedures performed in the UK, for the treatment of cardiac arrhythmias, over the last decade. This has been particularly notable for the treatment of atrial arrhythmias such as atrial flutter, atrial fibrillation, and atrio-ventricular nodal re-entry tachycardias (AVNRTs). Atrial fibrillation (AF) ablation procedures have increased from ,100 per yr in 2000 to over 3500 procedures in 2009. Anaesthetists are increasingly becoming involved in the provision of sedation or general anaesthesia for these procedures. There is a marked (10-fold) regional variation in cardiac electrophysiology services, with the majority of electrophysiology units concentrated in London and the South East. [178 procedures per million population take place in London compared with 18 procedures per million population in the North East 1 (CCAD).] Technologies for the treatment of arrhythmias are rapidly evolving and these techniques are associated with unique complications. This article will describe the techniques used by the cardiologists to map the arrhythmias and discuss the different techniques involved in ablation. It will consider the anaesthetic implications of these procedures and discuss the challenges of delivering safe anaesthesia in the cardiac catheter laboratory. Finally, the complications of these procedures will be emphasized to enable prevention, or rapid diagnosis and treatment.