Video-assisted thoracoscopic radiofrequency (RF) fragmentation of the left atrium effectively reduces the incidence of atrial fibrillation and risk of thromboembolic events. Anesthetic management of this surgery is still not regulated.

OBJECTIVE

To analyze clinical and laboratory features of perioperative period in RF fragmentation of the left atrium.

MATERIAL AND METHODS

A prospective observational study included 187 consecutive patients who underwent elective RF fragmentation. Demographic characteristics, anamnestic, laboratory and instrumental data were recorded. Central hemodynamic parameters, cerebral oximetry, bispectral index, acid-base balance were intraoperatively recorded. We assessed the features of early postoperative period, the need for noninvasive ventilation (NIV) and length of ICU-stay.

RESULTS

There were 153 (81.8%) men aged 60 [54; 65] years. Body mass index was 30 [27; 33] kg/m². The left atrium was enlarged by 14—38%, baseline cardiac index was reduced by 5—30%. Intraoperative period was characterized by supine position, intubation with a double-lumen endobronchial tube, alternating single-lung ventilation, pleural cavity communication, need for inotropic support, blood pressure decrease by 30%, pulmonary artery pressure increase by 30%, increase of pulmonary artery occlusion pressure up to 27 mm Hg and central venous pressure up to 16 mm Hg, cardiac index decrease to 1.6 l/min/m². Sinus rhythm recovered in 24 hours after surgery in 184 (98.4%) patients. Weaning from ventilator was performed in the operating theatre in 36 (19%) of patients. Postoperative NIV was needed in 13 (6.9%) patients. In 24 (12.8%) patients, length of ICU-stay was ≥2 days.

CONCLUSION

Intraoperative features occur due to the model of tension pneumothorax and mechanical compression of the left atrium. The main surgical stage is characterized by pronounced hemodynamic changes. Early correction of these changes makes it possible to prevent further hemodynamic and respiratory complications.