Deep neuromuscular blockade in radiofrequency catheter ablation may provide greater reduction in atrial fibrillation recurrence

1. Deep neuromuscular blockade in radiofrequency catheter ablation under general anesthesia reduced the atrial fibrillation recurrence rate compared to moderate neuromuscular blockade 

Evidence Rating Level: 1 (Excellent)

This randomized controlled trial investigated the impact of neuromuscular blockade depth on atrial fibrillation (AF) recurrence following radiofrequency catheter ablation (RFCA) under general anesthesia. The study compared moderate (Group M) and deep (Group D) neuromuscular blockade in 94 patients over a 12-month follow-up. Both groups underwent RFCA with standardized anesthesia protocols, differing only in the intensity of muscle relaxation monitored via train-of-four and post-tetanic counts. Key outcomes included the recurrence rates of AF and related symptoms, assessed through electrocardiographic diagnosis and clinical evaluations. There was a significant reduction in AF recurrence in Group D (25%) compared to Group M (46%), with a relative risk of 0.545. Symptom recurrence rates mirrored this trend, being notably lower in the deep blockade group (25% vs. 54%, p=0.003). Additionally, procedural stability and operator satisfaction were higher in the deep blockade group due to minimized diaphragmatic movements and improved catheter contact. However, no significant differences were observed in anesthesia or ablation durations. This suggests that deep neuromuscular blockade enhances RFCA efficacy by providing a stable surgical environment, leading to lower AF recurrence rates. This research underscores the importance of precise anesthetic management in optimizing RFCA outcomes and calls for further studies to confirm these results and explore long-term implications.

Click to read the study in PLOSONE

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