Use of general anesthesia to suppress incessant atrial fibrillation in a patient undergoing ablation for supraventricular tachycardia

Abstract

Atrial fibrillation (AF) can occur in up to 30% of patients with supraventricular tachycardias (SVT) mediated by atrioventricular accessory pathways (AP).1, 2, 3, 4 When it occurs in the course of an electrophysiological (EP) study, mapping and ablation of the SVT is difficult, especially when ventricular pre-excitation is not present. In this case, we report a patient with atrioventricular reciprocating tachycardia (AVRT) mediated by a concealed posterior septal AP in whom repetitive and sustained AF during EP study required conversion from conscious sedation to general anesthesia (GA) for suppression of AF. Key Teaching Points • In patients with longstanding paroxysmal supraventricular tachycardia (SVT), atrial electrical remodeling can result in difficult-to-control paroxysmal atrial fibrillation (AF). • When sedation and anxiolytic agents fail to control incessant AF, general anesthesia attenuates adrenergic drive sufficiently to suppress incessant AF during SVT ablation. • Ablation of the accessory pathway (AP) in patients with atrioventricular reciprocating tachycardia can result in prevention of further AF episodes in about 90% of patients. However, the incidence of AF in patients with APs is higher than that of the general population even after AP ablation.