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Laryngeal mask airway versus endotracheal intubation as general anesthesia airway managements for atrial fibrillation catheter ablation: a comparative analysis based on propensity score matching

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Abstract

Background

The current evidence on the use of laryngeal mask airway (LMA) as an airway management technique for general anesthesia (GA) during atrial fibrillation (AF) catheter ablation (CA) is insufficient. This study aims to compare the feasibility, safety, and clinical benefits of LMA and endotracheal intubation (ETI) for airway management in AF CA.

Methods

One hundred fifty-two consecutive patients with AF who underwent CA under GA were included and divided into two groups based on different airway management methods (66 in the LMA group, 86 in the ETI group). After propensity score matching, a final analysis cohort of 132 patients was obtained to compare procedural parameters, adverse events, and prognosis between the two groups.

Results

The LMA group exhibited significantly shorter total procedural time (p = 0.039), anesthesia induction time (p = 0.015), and recovery time (p = 0.006) compared to the ETI group. The mean arterial pressure (MAP) and heart rate were significantly lower in the LMA group during extubation and 1-min post-extubation (p < 0.05). Furthermore, the LMA group demonstrated lower MAP levels during intubation (p = 0.029). The incidences of intraoperative hypotension (p = 0.017) and bradycardia (p = 0.032) were significantly lower in the LMA group. The incidences of delayed recovery or delirium (p = 0.027), laryngeal or airway injury (p = 0.016), cough or bucking (p = 0.001), and sore throat (p < 0.001) were significantly lower in the LMA group. There were no statistically significant differences in catheter stability parameters and sinus rhythm maintenance rates between the two groups (p > 0.05).

Conclusion

LMA is feasible, safe, and effective in AF CA as an optimized airway management technique for GA.

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Abbreviations

ACT:

Activated coagulation time

AF:

Atrial fibrillation

AI:

Ablation index

CA:

Catheter ablation

CF:

Contact force

ECG:

Electrocardiogram

ETI:

Endotracheal intubation

GA:

General anesthesia

HR:

Heart rate

LMA:

Laryngeal mask airway

MAP:

Mean arterial pressure

NOAC:

Novel oral anticoagulant

PAF:

Paroxysmal atrial fibrillation

PsAF:

Persistent atrial fibrillation

PSM:

Propensity score matching

PVI:

Pulmonary vein isolation

RF:

Radiofrequency

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Funding

This study was supported by the National Natural Science Foundation of China (Grant/Award Number: 82000426); the Natural Science Foundation of Shanxi Province, China (Grant/Award Number: 201801D121222 and 201801D121337); and the Cultivation Project of Young and Middle-aged Academic Leaders of the First Hospital of Shanxi Medical University (Grant/Award Number: YD1609).

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Authors and Affiliations

  1. Shanxi Medical University, Taiyuan, Shanxi, China

    Naidong Pang, Ruizhe Chen, Binghang Zhang & Zhen Yang

  2. Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

    Naidong Pang

  3. Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China

    Feifei Pan, Zhen Yang, Min Guo & Rui Wang

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  1. Naidong Pang
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  2. Feifei Pan
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  3. Ruizhe Chen
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  4. Binghang Zhang
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  5. Zhen Yang
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  6. Min Guo
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  7. Rui Wang
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Contributions

Study concept and design: RW and NP. Data acquisition: NP, FP, RC, and BZ. Formal analysis: NP, FP, and ZY. Writing—original draft preparation: NP; writing—review and editing: RW and MG. Funding acquisition: RW and MG.

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Correspondence to Rui Wang.

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Pang, N., Pan, F., Chen, R. et al. Laryngeal mask airway versus endotracheal intubation as general anesthesia airway managements for atrial fibrillation catheter ablation: a comparative analysis based on propensity score matching. J Interv Card Electrophysiol (2024). https://doi.org/10.1007/s10840-024-01742-w

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