• Eyal Nof, Tobias Reichlin, Alan D Enriquez, Justin Ng, Koichi Nagashima, Michifumi Tokuda, Chirag Barbhaiya, Roy M John, Gregory F Michaud, Usha Tedrow, Wendy Gross, and William G Stevenson.
• Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel; Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: eyal.nof@sheba.health.gov.il.
• Heart Rhythm. 2015 Nov 1; 12 (11): 2213-20.

BackgroundRadiofrequency ablation of ventricular tachycardia (VT) may be performed with general anesthesia (GA) or conscious sedation; however, comparative data are limited.ObjectiveThe purpose of the study was to assess the effects of GA on VT inducibility and stability.MethodsA retrospective comparison of 226 patients undergoing radiofrequency ablation for scar-related VT under GA or intravenous conscious sedation was performed. Data were then prospectively collected in 73 patients undergoing noninvasive programmed stimulation (NIPS) while awake, followed by GA and invasive programmed stimulation for VT induction.ResultsIn the retrospective study, groups did not differ in VT inducibility, complications, or abolition of clinical VT. Intravenous hemodynamic support was used more often in the GA group. In the prospective group, 12 patients (16%) were noninducible with NIPS. Of the 61 patients with inducible VT with NIPS, 5 (8%) were noninducible with GA, 25 (41%) were inducible with more aggressive simulation, and 31 (51%) were inducible with the same or less aggressive stimulation. Of the 56 patients who were inducible with NIPS and under GA, 28 (50%) had the same induced VTs and 28 (50%) had different induced VTs. In 23 of 56 patients, the clinical VT morphology was known. The clinical VT was reproduced with NIPS in 17 of 23 patients (74%) and under GA in 13 of 23 patients (59%). Under GA, nonclinical VTs were more often induced in patients with a lower ejection fraction and nonischemic cardiomyopathy.ConclusionGA does not prevent inducible VT in the majority of patients. GA is associated with an increased use of hemodynamic support, but this did not adversely affect VT stability or procedure outcomes.Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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