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Randomized Controlled Trial
. 2025 Jan 21;20(1):e0302952.
doi: 10.1371/journal.pone.0302952. eCollection 2025.

Deep neuromuscular blockade during radiofrequency catheter ablation under general anesthesia reduces the prevalence of atrial fibrillation recurrence when compared to moderate neuromuscular blockade: A randomized controlled trial

Eun Jung Oh  1 , Jae-Geum Shim  1 , Suyong Jeon  1 , Eun Ah Cho  1 , Sung Hyun Lee  1 , Taeho Jeong  1 , Jin Hee Ahn  1
Affiliations
Randomized Controlled Trial

Deep neuromuscular blockade during radiofrequency catheter ablation under general anesthesia reduces the prevalence of atrial fibrillation recurrence when compared to moderate neuromuscular blockade: A randomized controlled trial

Eun Jung Oh et al. PLoS One. .

Abstract

Background: Proper anesthesia management is required to maintain immobilization and stable breathing of the patient to improve catheter contact and stability during catheter ablation for PVI. However, it remains unclear whether the depth of neuromuscular blockade affects the results of RFCA under general anesthesia.

Methods: The patients were randomly assigned to either the moderate neuromuscular blockade group (Group M, train-of-four 1 to 2) or the deep neuromuscular blockade group (Group D, posttetanic count 1-2). The primary outcome was the 12-month AF recurrence rate using confirmed electrocardiographic diagnosis after the ablation procedure at two different neuromuscular blockade depths.

Results: Total 94 patients (47 in each group) were included in the analysis. Recurrence of AF during the A 12-month follow-up was 12 (25%) in group D and 22 (46%) in group M. The AF recurrence rate was significantly higher in group M (p = 0.03). The relative risk (RR) for the risk of 12-month AF recurrence was 0.545 in group D. AF symptom recurrence was observed during the A 12-month follow-up in 12 (25%) and 26 (54%) patients in groups D and M, respectively.

Conclusions: Compared to moderate neuromuscular blockade, deep neuromuscular blockade while performing RFCA under general anesthesia reduced 12-month AF recurrence rate. Deep neuromuscular blockade under general anesthesia is thought to increase the success rate by providing a stable surgical environment during the RFCA procedure.

Trial registration: Clinical trials of Korea KCT 0003371.

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Conflict of interest statement

No authors have competing interests.

Figures

Fig 1
Fig 1. The CONSORT flow diagram.
Fig 2
Fig 2. Kaplan–Meier analysis.
Kaplan-Meier curves shows cumulative probability of AF-free survival (A) and AF symptom-free survival (B) according to degree of neuromuscular blockade after radiofrequency ablation procedure.
See this image and copyright information in PMC

References

    1. Cheung CC, Nattel S, Macle L, Andrade JG. Management of atrial fibrillation in 2021: an updated comparison of the current CCS/CHRS, ESC, and AHA/ACC/HRS guidelines. Can J Cardiol. 2021;37(10):1607–18. Epub 20210626. doi: 10.1016/j.cjca.2021.06.011 - DOI - PubMed
    1. Mujovi––– N, Marinković M, Lenarczyk R, Tilz R, Potpara TS. Catheter ablation of atrial fibrillation: an overview for clinicians. Adv Ther. 2017;34(8):1897–917. Epub 2017/07/25. doi: 10.1007/s12325-017-0590-z ; PMCID: PMCPMC5565661 - DOI - PMC - PubMed
    1. Ganesan AN, Shipp NJ, Brooks AG, Kuklik P, Lau DH, Lim HS, et al.. Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(2):e004549. Epub 2013/03/30. doi: 10.1161/jaha.112.004549 ; PMCID: PMCPMC3647286 - DOI - PMC - PubMed
    1. Di Biase L, Conti S, Mohanty P, Bai R, Sanchez J, Walton D, et al.. General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study. Heart Rhythm. 2011;8(3):368–72. Epub 2010/11/09. doi: 10.1016/j.hrthm.2010.10.043 - DOI - PubMed
    1. Chikata A, Kato T, Yaegashi T, Sakagami S, Kato C, Saeki T, et al.. General anesthesia improves contact force and reduces gap formation in pulmonary vein isolation: a comparison with conscious sedation. Heart Vessels. 2017;32(8):997–1005. Epub 2017/03/06. doi: 10.1007/s00380-017-0961-z - DOI - PubMed

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