Difficult ventilation with suspected laryngospasm in patients undergoing pulsed field ablation for atrial fibrillation under general anesthesia using laryngeal mask airway: A case series

Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). 1 Recently, pulsed field ablation (PFA) has emerged as a novel, nonthermal technique delivering high-voltage, ultrashort-duration electrical pulses that induce irreversible electroporation in myocardial cells, enabling selective tissue ablation.Compared with conventional thermal sources such as radiofrequency or cryoablation, PFA may reduce injury to adjacent structures such as the esophagus and phrenic nerve. 2 Despite promising safety features, PFA is relatively new, and its complications and long-term safety remain under investigation.High-voltage pulses during PFA can cause significant muscular and diaphragmatic contractions, often necessitating deep sedation or general anesthesia. 3For airway management during catheter ablation for AF under general anesthesia, a laryngeal mask airway (LMA) is widely used owing to its lower invasiveness and ease of insertion compared with endotracheal intubation. 4However, using an LMA without neuromuscular blocking agents (NMBAs) during general anesthesia poses a risk of sudden difficult ventilation, primarily owing to laryngospasm. 5e report 3 cases of suspected laryngospasm during PVI with PFA, all performed under general anesthesia using an LMA.