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Effects of remimazolam on hemodynamic changes during cardiac ablation for atrial fibrillation under general anesthesia: a propensity-score-matched retrospective cohort study

Effets du remimazolam sur les changements hémodynamiques au cours de l’ablation cardiaque pour fibrillation auriculaire sous anesthésie générale : une étude de cohorte rétrospective appariée par score de propension

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Abstract

Purpose

Abrupt hemodynamic changes or life-threatening arrhythmias are frequently observed in individuals receiving anesthesia for cardiac arrhythmia ablation. Remimazolam is a novel ultra-short-acting benzodiazepine that has been associated with better hemodynamic stability than conventional anesthetic agents do. This study aimed to investigate whether remimazolam reduces vasoactive agent use compared with desflurane in individuals undergoing ablation for atrial fibrillation under general anesthesia.

Methods

In a retrospective cohort study, we reviewed electronic medical records of adult patients who underwent ablation for atrial fibrillation under general anesthesia between July 2021 and July 2022. We divided patients into remimazolam and desflurane groups according to the principal agent used for anesthesia. The primary endpoint was the overall incidence of vasoactive agent use. We compared the groups using propensity-score matching (PSM) analysis.

Results

A total of 177 patients were included—78 in the remimazolam group and 99 in the desflurane group. After PSM, 78 final patients were included in each group. The overall incidence of vasoactive agent use was significantly lower in the remimazolam group than in the desflurane group (41% vs 74% before PSM; 41% vs 73% after PSM; both, P < 0.001). The incidence rate, duration, and maximum dose of continuous vasopressor infusion were also significantly lower in the remimazolam group (P < 0.001). Use of remimazolam was not associated with increased complications after the ablation procedures.

Conclusions

General anesthesia using remimazolam vs desflurane was associated with significantly reduced vasoactive agent requirement and better hemodynamic stability without increased postoperative complications in patients undergoing ablation for atrial fibrillation.

Résumé

Objectif

Des changements hémodynamiques brusques ou des arythmies potentiellement mortelles sont fréquemment observés chez les personnes recevant une anesthésie pour une ablation d’arythmie cardiaque. Le remimazolam est une nouvelle benzodiazépine à action ultra-courte qui a été associé à une meilleure stabilité hémodynamique que les agents anesthésiques conventionnels. Cette étude visait à déterminer si le remimazolam réduit l’utilisation d’agents vasoactifs par rapport au desflurane chez les personnes bénéficiant d’une ablation pour fibrillation auriculaire sous anesthésie générale.

Méthode

Dans une étude de cohorte rétrospective, nous avons examiné les dossiers médicaux électroniques de patient·es adultes ayant bénéficié d’une ablation pour fibrillation auriculaire sous anesthésie générale entre juillet 2021 et juillet 2022. Nous avons divisé les patient·es en groupes de remimazolam et de desflurane en fonction de l’agent principal utilisé pour l’anesthésie. Le critère d’évaluation principal était l’incidence globale de l’utilisation d’agents vasoactifs. Nous avons comparé les groupes à l’aide d’une analyse d’appariement par score de propension (ASP).

Résultats

Au total, 177 patient·es ont été inclus·es, dont 78 dans le groupe remimazolam et 99 dans le groupe desflurane. Après l’ASP, 78 patient·es ont été inclus·es au final dans chaque groupe. L’incidence globale d’utilisation d’agents vasoactifs était significativement plus faible dans le groupe remimazolam que dans le groupe desflurane (41 % vs 74 % avant l’ASP; 41 % vs 73 % après l’ASP; les deux P < 0,001). Le taux d’incidence, la durée et la dose maximale de perfusion continue de vasopresseurs étaient également significativement plus faibles dans le groupe remimazolam (P < 0,001). L’utilisation de remimazolam n’a pas été associée à une augmentation des complications après les interventions d’ablation.

Conclusion

L’anesthésie générale à base de remimazolam vs desflurane a été associée à une réduction significative des besoins en agents vasoactifs et à une meilleure stabilité hémodynamique sans augmentation des complications postopératoires chez les patient·es bénéficiant d’une ablation pour fibrillation auriculaire.

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Author contributions

Sun Woo Nam, In-Ae Song, and Kyoung-Woon Joung contributed to the study design and drafting of the paper. Subin Yim, Chang Ik Choi, Insun Park, Sun Woo Nam, and In-Ae Song contributed to data acquisition. Sun Woo Nam, In-Ae Song, Chang Ik Choi, and Insun Park contributed to data analysis. Sun Woo Nam, In-Ae Song, and Kyoung-Woon Joung contributed to data interpretation and critical revisions of the paper.

Disclosures

The authors claimed no conflicts of interest.

Funding statement

None.

Editorial responsibility

This submission was handled by Dr. Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea

    Subin Yim MD, Insun Park MD, PhD & In-Ae Song MD, PhD

  2. Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea

    In-Ae Song MD, PhD

  3. Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, South Korea

    Kyoung-Woon Joung MD

  4. Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul, South Korea

    Kyoung-Woon Joung MD

  5. Department of Anesthesiology and Pain Medicine, Chung-Ang University, College of Medicine, Seoul, South Korea

    Sun Woo Nam MD, PhD

  6. Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, South Korea

    Sun Woo Nam MD, PhD

  7. Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju-si, South Korea

    Chang Ik Choi MD

  8. Department of Anesthesiology and Pain Medicine, Wonju Severance Christian Hospital, Wonju-si, South Korea

    Chang Ik Choi MD

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Nam, S.W., Yim, S., Choi, C.I. et al. Effects of remimazolam on hemodynamic changes during cardiac ablation for atrial fibrillation under general anesthesia: a propensity-score-matched retrospective cohort study. Can J Anesth/J Can Anesth 70, 1495–1503 (2023). https://doi.org/10.1007/s12630-023-02514-2

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