Anesthetic Management for Ventricular Tachycardia Ablation: A National Anesthesia Clinical Outcomes Registry Analysis

Abstract

Objectives: We analyzed anesthetic management trends during ventricular tachycardia (VT) ablation, hypothesizing that (1) monitored anesthesia care (MAC) is more commonly used than general anesthesia (GA), (2) MAC use significantly increased after release of the 2019 Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias, and (3) anesthetic approach varies based on patient and hospital characteristics. Design: Retrospective study. Setting: National Anesthesia Clinical Outcomes Registry data. Participants: Patients ≥18 years who underwent elective VT ablation between 2013-2021. Interventions: None. Measurements and main results: Covariates were selected a priori within multivariate models, and interrupted time-series analysis was performed. Of the 15,505 patients who underwent VT ablation between 2013-2021, 9,790 (63.1%) received GA. After the 2019 Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias supported avoidance of GA, no statistically significant increase in MAC was evident (immediate change in intercept post-consensus statement release AOR 1.41, p=0.1629; change in slope post-consensus statement release AOR 1.06 per quarter, p=0.1591). Multivariate analysis demonstrated that sex, ASA physical status, age, and geographic location were statistically significantly associated with anesthetic approach. Conclusions: GA has remained the primary anesthetic type for VT ablation despite the 2019 Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias suggesting its avoidance in idiopathic VT. Achieving widespread clinical practice change is an ongoing challenge in medicine, emphasizing the importance of developing effective implementation strategies to facilitate awareness of guideline release and subsequent adherence to and adoption of recommendations.