Atrial Fibrillation Clinical Trial
Official title:
General Anesthesia With Endotracheal Tube Versus Laryngeal Mask Airway in Patients Undergoing Catheter Ablation for Atrial Fibrillation, a Non-inferiority Trial
Verified date | January 2020 |
Source | Virginia Commonwealth University |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
In recent years it has been shown that catheter ablation of symptomatic atrial fibrillation
(PAF) is superior to antiarrhythmic drug therapy with regards to effectiveness and clinical
outcomes. Atrial fibrillation is the most common cardiac arrhythmia, with high rates of
concomitant heart failure, stroke and mortality. During an ablation procedure, a patient can
be managed with intravenous sedation or General Anesthesia (GA). Within this setting, General
anesthesia is associated with improved procedure time and cure rate compared to sedation.
Airway management during GA can be achieved through a laryngeal mask airway (LMA) or an
endotracheal tube (ETT). The use of LMA compared to ETT has been shown in different surgical
populations to decrease procedure and recovery time, improve hemodynamic stability and reduce
anesthetic requirements. It has also shown to decrease airway complications, and
postoperative nausea/vomiting which are important factors that affect overall patient
satisfaction.
Although general anesthesia in electrophysiology procedures is associated with a higher cure
rate, there have been reports of increased airway trauma.Additionally, it is believed that
volatile anesthetics may be associated with increased ventricular action potential duration
as well as prolonged QT interval. The increased usage of opioids during general anesthesia is
also thought to interfere with electrophysiology studies by affecting vagal tone.
At Virginia Commonwealth University (VCU) Health system, Anesthesiologists have been
successfully using LMA (General Anesthesia) for ablation in PAF in eligible patients for over
five years. The investigators plan to perform a retrospective review of all patients who
underwent catheter ablation of PAF at Virginia Commonwealth University Health System from
January 2014 - December 2015. The primary endpoint evaluated will be procedure time. Other
data collected will include demographics, cardiac history, type of anesthesia, amount of
intra-procedure opioids, time to discharge from post anesthesia care unit (PACU), total
length of hospital stay, intra-procedure hemodynamics, intra-procedure
ionotrope/chronotrope/pressor requirements. and atrial fibrillation recurrence at a 3 month
follow-up.
Status | Completed |
Enrollment | 100 |
Est. completion date | January 31, 2019 |
Est. primary completion date | December 11, 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 99 Years |
Eligibility |
Inclusion Criteria: - Patients undergoing primary ablation for paroxysmal atrial fibrillation - Able to obtain consent in English language - BMI <35 Exclusion Criteria: - Patients <18 years old - Patients undergoing ablation for arrhythmias other than paroxysmal atrial fibrillation - American Society of Anesthesiologist physical status of 4 or greater - Patients undergoing repeat ablation - BMI >35 - Pregnancy - Prisoners - Patients unable to give their own consent - Patients having trans esophageal echo on the same day - Patients unable to give consent in English language - Patients will also be excluded if the attending anesthesiologist determines that they would not be suitable candidates for intubation with either method (ETT tube or LMA mask). - Patients with severe gastroesophageal reflux disease - Patients with high risk of aspiration |
Country | Name | City | State |
---|---|---|---|
United States | Virginia Commonwealth University | Richmond | Virginia |
Lead Sponsor | Collaborator |
---|---|
Virginia Commonwealth University |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Procedure Time (Minutes) | Will be measured as time from start of procedure to end of procedure, as recorded in minutes | Up to 270 minutes | |
Secondary | Fluoroscopy Time | As measured and reported by electrophysiology and radiology notes, recorded in minutes | Up to 270 minutes | |
Secondary | Total Anesthesia Time | Total anesthesia time as measured in minutes and recorded in the anesthesia record, from anesthesia start time to anesthesia stop time | Up to 270 minutes | |
Secondary | Time to Discharge From PACU | time from arrival to PACU until discharge from anesthesia care | Up to 7 days | |
Secondary | Total Intra-procedure Opioids | Measured in mcg of Fentanyl | Up to 270 minutes | |
Secondary | Anesthetic Requirements | average end tidal volatile anesthetics Measured as intra operative anesthetic (MAC) | Up to 270 minutes | |
Secondary | Anesthetic Requirements | average amount of intravenous anesthetics | Up to 270 minutes | |
Secondary | Intraoperative Hemodynamics | heart rate (beats per minute) | Up to 270 minutes | |
Secondary | Intraoperative Hemodynamics | mean arterial pressure | Up to 270 minutes | |
Secondary | Intraoperative Hemodynamics | systolic blood pressure | Up to 270 minutes | |
Secondary | Intraoperative Hemodynamics | diastolic blood pressure | Up to 270 minutes | |
Secondary | Intraprocedure Pressor/Ionotrope/Chronotrope Requirements | total measured amounts of all pressors/ionotropes and chronotropes administered intraoperatively | Up to 270 minutes | |
Secondary | Electrophysiology Parameters | duration of paroxysmal atrial fibrillation prior to procedure | Up to 270 minutes | |
Secondary | Electrophysiology Parameters | size of left atrium (mm) | Up to 270 minutes | |
Secondary | Electrophysiology Parameters | left ventricular ejection fraction | Up to 270 minutes | |
Secondary | Airway Trauma | Any noted trauma in the anesthesia or post-procedure notes, including damage to lips/teeth, laryngospasm, need for reintubation post procedure | Up to 7 days | |
Secondary | Post-procedure Nausea | Measured by number of doses of antiemetics given in the post-procedure time period mg of Zofran (ondanesteron) given post-operatively | Up to 7 days | |
Secondary | Post-procedure Emesis | Measured by number of times patient has emesis during post-procedure time period | Up to 7 days | |
Secondary | Atrial Fibrillation Recurrence | defined as recurrence of paroxysmal atrial fibrillation recurring at any time after 6 weeks past the day of procedure. As standard of care these patients are followed up with Holter monitoring for a period of 6 months. Holter monitoring will be done for 48 hour time periods immediately post-procedure, 2 weeks, 6 weeks, 4 months and 6 months post procedure as is standard of care | From end of procedure to six month followup holter monitor | |
Secondary | Aspiration Events | aspiration events as noted in the anesthesia, PACU and post procedure notes would be documented | Up to 7 days | |
Secondary | Patient Satisfaction | patients will be given an survey by study personnel prior to discharge from the hospital; survey will be conducted in person by study personnel | Up to six months | |
Secondary | Cost Analysis | an analysis of cost to patient as well as overall hospital costs will be conducted | Up to six months |
Status | Clinical Trial | Phase | |
---|---|---|---|
Recruiting |
NCT05654272 -
Development of CIRC Technologies
|
||
Terminated |
NCT04115735 -
His Bundle Recording From Subclavian Vein
|
||
Completed |
NCT04571385 -
A Study Evaluating the Efficacy and Safety of AP30663 for Cardioversion in Participants With Atrial Fibrillation (AF)
|
Phase 2 | |
Completed |
NCT05366803 -
Women's Health Initiative Silent Atrial Fibrillation Recording Study
|
N/A | |
Completed |
NCT02864758 -
Benefit-Risk Of Arterial THrombotic prEvention With Rivaroxaban for Atrial Fibrillation in France
|
||
Recruiting |
NCT05442203 -
Electrocardiogram-based Artificial Intelligence-assisted Detection of Heart Disease
|
N/A | |
Completed |
NCT05599308 -
Evaluation of Blood Pressure Monitor With AFib Screening Feature
|
N/A | |
Completed |
NCT03790917 -
Assessment of Adherence to New Oral anTicoagulants in Atrial Fibrillation patiEnts Within the Outpatient registrY
|
||
Enrolling by invitation |
NCT05890274 -
Atrial Fibrillation (AF) and Electrocardiogram (EKG) Interpretation Project ECHO
|
N/A | |
Recruiting |
NCT05266144 -
Atrial Fibrillation Patients Treated With Catheter Ablation
|
||
Recruiting |
NCT05316870 -
Construction and Effect Evaluation of Anticoagulation Management Model in Atrial Fibrillation
|
N/A | |
Not yet recruiting |
NCT06023784 -
The Impact of LBBAP vs RVP on the Incidence of New-onset Atrial Fibrillation in Patients With Atrioventricular Block
|
N/A | |
Recruiting |
NCT05572814 -
Transform: Teaching, Technology, and Teams
|
N/A | |
Recruiting |
NCT04092985 -
Smart Watch iECG for the Detection of Cardiac Arrhythmias
|
||
Completed |
NCT04087122 -
Evaluate the Efficiency Impact of Conducting Active Temperature Management During Cardiac Cryoablation Procedures
|
N/A | |
Completed |
NCT06283654 -
Relieving the Emergency Department by Using a 1-lead ECG Device for Atrial Fibrillation Patients After Pulmonary Vein Isolation
|
||
Recruiting |
NCT05416086 -
iCLAS™ Cryoablation System Post-Market Clinical Follow-up (PMCF) Study
|
N/A | |
Completed |
NCT05067114 -
Solutions for Atrial Fibrillation Edvocacy (SAFE)
|
||
Completed |
NCT04546763 -
Study Watch AF Detection At Home
|
||
Completed |
NCT03761394 -
Pulsewatch: Smartwatch Monitoring for Atrial Fibrillation After Stroke
|
N/A |