BMC Anesthesiology· 2026Q2· Case report
Anesthetic management for pulsed field ablation in a patient with Eisenmenger syndrome using general anesthesia with spontaneous ventilation: a case report
- 0citations
- Q2SCImago
- 2026year
Short summary
General anesthesia with spontaneous ventilation via a laryngeal mask airway enabled successful pulsed field ablation (PFA) for drug-refractory atrial tachyarrhythmia in a 48-year-old male with Eisenmenger syndrome and severe pulmonary hypertension.
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Key points
- Pulsed field ablation (PFA) is a potential treatment for atrial tachyarrhythmia in Eisenmenger syndrome (ES) patients but poses anesthetic challenges.
- General anesthesia with spontaneous ventilation and a laryngeal mask airway was used to manage a 48-year-old male with ES.
- This anesthetic approach avoided positive intrathoracic pressure, preserving right ventricular preload and maintaining hemodynamic stability during PFA.
- The PFA procedure was successfully completed, achieving acute rhythm control, though the patient later died from progressive heart failure.
AI-generated from the title and abstract; the full text is not read.
Abstract
Abstract Background Drug-refractory atrial tachyarrhythmia is an important precipitating factor for recurrent heart failure decompensation in patients with Eisenmenger syndrome (ES). Although percutaneous pulsed field ablation (PFA) represents a potential therapeutic option for arrhythmia management, its application in this population is challenging due to the substantial anesthetic risks associated with severe pulmonary hypertension, right ventricular dysfunction, and profound hypoxemia. Case presentation We report the case of a 48-year-old male with ES and chronic heart failure who presented with recurrent, drug-refractory atrial flutter/fibrillation. Given concerns regarding hemodynamic deterioration during positive pressure ventilation, general anesthesia with spontaneous ventilation supported by a laryngeal mask airway was selected. The PFA was successfully completed without intraoperative hemodynamic instability. The patient was transferred to the ward with supplemental oxygen support. However, despite successful arrhythmia ablation and favorable intraprocedural physiology, he developed progressive heart failure and multiorgan dysfunction and died 20 days after the procedure. Conclusion The safe implementation of PFA relies on absolute immobility and stable hemodynamics. An anesthesia strategy utilizing general anesthesia with a laryngeal mask airway and spontaneous ventilation avoids the deleterious effects of positive intrathoracic pressure on right ventricular preload, allowing the PFA procedure to be completed with stable physiology and acute rhythm control.
The authors' abstract, as published at the source. BMC Anesthesiology, 2026 · DOI ↗
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Field: Cardiology and Cardiovascular Medicine
Cardiology and Cardiovascular MedicineMedicine