Comparison of total intravenous anesthesia versus volatile anesthesia on arrhythmia inducibility and clinical outcomes during catheter ablation for ventricular tachycardia

Introduction: Catheter ablation is highly efficacious for the treatment of ventricular tachycardia (VT). In patients with structural heart disease, catheter ablation may be performed under general anesthesia (GA). There are limited data on the effect of anesthetic agents on VT inducibility. We compared VT inducibility using total intravenous anesthesia (TIVA) versus volatile anesthesia. Methods: In this retrospective observational study, patients who underwent catheter ablation for VT between January 2019 and May 2023 were included. Clinical data, procedural reports, and long-term outcomes were collected from the electronic medical records. Patients were grouped based on the type of anesthetic agent used to maintain GA during the procedure. Results: There were 207 patients maintained under GA using TIVA and 56 patients using volatile anesthesia. One hundred and seventy-five of the 207 (84.5%) patients in the TIVA group were inducible for VT compared to 38 of 56 (67.9%) in the volatile group (OR [95% CI]: 3.8 [1.4–10.4], p = 0.01). Male sex was identified as a potential factor associated with increased VT inducibility (OR [95% CI]: 4.7 [1.4–16.0], p = 0.01). TIVA patients had a shorter ventricular effective refractory period. However, there was no difference between either the number of extra stimuli needed to induce the VT, the proportion of VTs induced spontaneously, acute ablation success rate, or the incidence of VA recurrence. Conclusion: Use of volatile GA agents was associated with a higher incidence of VT non-inducibility compared to TIVA. TIVA was associated with a lower risk of VA recurrence in follow-up. The observed effect on VT inducibility could be explained by effects on ventricular effective refractory period.