Sedation Versus General Anesthesia During Pediatric Electrophysiology Studies: A Paired Comparison

BACKGROUND: Anesthetic strategy may influence tachycardia inducibility during pediatric electrophysiology studies, but direct paired comparisons between sedation and general anesthesia remain limited. METHODS: This prospective paired-comparison study included 51 pediatric patients aged 5-21 years with supraventricular tachycardia undergoing electrophysiology study under both procedural sedation and general anesthesia during the same session. Procedural sedation consisted of midazolam, fentanyl, and supplemental propofol boluses as needed. General anesthesia was induced with propofol and fentanyl and maintained with sevoflurane. Tachycardia inducibility and electrophysiological parameters were compared between anesthetic conditions using paired analyses. RESULTS: Overall tachycardia inducibility was higher during sedation than during general anesthesia (40/51 [78.4%] vs. 29/51 [56.9%], p = 0.007). No significant differences were observed in atrial effective refractory period, ventricular effective refractory period, atrioventricular nodal Wenckebach point, jump, echo interval, or ventriculoatrial block duration. In patients with atrioventricular nodal reentrant tachycardia, inducibility decreased from 84.0% during sedation to 60.0% during general anesthesia (p = 0.109). In the Wolff-Parkinson-White/atrioventricular reentrant tachycardia subgroup, inducibility decreased from 73.1% to 53.8% (p = 0.063), and the accessory pathway effective refractory period, measured by extrastimulus pacing, was prolonged under general anesthesia (p = 0.018). CONCLUSIONS: Procedural sedation was associated with greater overall tachycardia inducibility than general anesthesia during pediatric electrophysiology studies. The AVNRT and WPW/AVRT subgroups showed numerically lower inducibility under general anesthesia in the same direction as the overall finding, although these subgroup differences did not reach statistical significance. These findings support individualized anesthetic planning that considers the arrhythmia substrate, the need to preserve inducibility for mapping and post-ablation validation, and patient-specific requirements for procedural stability.