Optimal anesthetic technique for thoracoscopic radiofrequency epicardial ablation of the left atrium

Marey I.S.; Klypa T.V.; Mandel I.A.; Vachev S.A.; Zotov A.S.

doi:https://doi.org/10.17116/anaesthesiology202602159

Marey I.S.

Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies, Moscow, Russia

ORCID: 0000-0001-6133-7190

Klypa T.V.

Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies, Moscow, Russia

ORCID: 0000-0002-2732-967X

Mandel I.A.

Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies, Moscow, Russia;
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

ORCID: 0000-0001-9437-6591

Vachev S.A.

Loginov Moscow Clinical Scientific Center, Moscow, Russia

ORCID: 0000-0002-2747-3057

Zotov A.S.

Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies, Moscow, Russia

ORCID: 0000-0003-0494-0211

Optimal anesthetic technique for thoracoscopic radiofrequency epicardial ablation of the left atrium

Authors:

Marey I.S., Klypa T.V., Mandel I.A., Vachev S.A., Zotov A.S.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2026;(2): 59‑68

DOI: 10.17116/anaesthesiology202602159

Read: 319 times

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To cite this article:

Marey IS, Klypa TV, Mandel IA, Vachev SA, Zotov AS. Optimal anesthetic technique for thoracoscopic radiofrequency epicardial ablation of the left atrium. Russian Journal of Anesthesiology and Reanimatology. 2026;(2):59‑68. (In Russ.)
https://doi.org/10.17116/anaesthesiology202602159

Использование инфографики авторами научных работ

OBJECTIVE. T

O determine the optimal anesthetic technique for thoracoscopic radiofrequency epicardial ablation of the left atrium.

MATERIAL AND METHODS

The study included 187 patients who underwent thoracoscopic radiofrequency ablation. Of these, 126 ones were in prospective part. Patients were divided into two groups according to anesthesia: total intravenous anesthesia with mechanical ventilation and combined endotracheal anesthesia. Central hemodynamics, mechanical ventilation, and acid-base status were recorded intraoperatively at three stages of intervention. We analyzed characteristics of early postoperative period and postoperative morbidity.

RESULTS

Intraoperative stage is characterized by supine position, alternate single-lung ventilation and communication between pleural cavities. The median of BIS in the combined endotracheal anesthesia group changed between stages: 67 (beginning of surgery) — 40 (main stage) — 57 (end of surgery). In the total intravenous anesthesia group, BIS was stable. At the main stage, FiO₂ set to maintain optimal PaO₂ and SatO₂ was 80 [60; 80] in the CEA group and 50 [45;70] in the intravenous anesthesia group. No dependency between anesthetic technique and intra-/postoperative complications was found. Cardiac index at the beginning of surgery was higher in the total intravenous anesthesia group. Sympathomimetic support increased cardiac index to normal values.

CONCLUSION

Total intravenous anesthesia is safe for thoracoscopic radiofrequency epicardial ablation of the left atrium regarding stable anesthesia and optimal gas exchange indicators. Total intravenous anesthesia combined with inotropic support allowed for higher cardiac index and smaller hemodynamic changes.

Keywords:

anesthesiology

pulmonary vein isolation

cardiac surgery

radiofrequency ablation

intensive care

thoracoscopy

atrial fibrillation

Authors:

Marey I.S.

Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies, Moscow, Russia

ORCID: 0000-0001-6133-7190

Klypa T.V.

Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies, Moscow, Russia

ORCID: 0000-0002-2732-967X

Mandel I.A.

Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies, Moscow, Russia;
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

ORCID: 0000-0001-9437-6591

Vachev S.A.

Loginov Moscow Clinical Scientific Center, Moscow, Russia

ORCID: 0000-0002-2747-3057

Zotov A.S.

Federal Scientific Clinical Center for Specialized Medical Care and Medical Technologies, Moscow, Russia

ORCID: 0000-0003-0494-0211

Received:

03.03.2025

Accepted:

20.11.2025

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References:

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