Can Transesophageal Echocardiography Be Performed Safely Using a Laryngeal Mask Airway During Atrial Fibrillation Ablation?

J Cardiothorac Vasc Anesth. 2018 Apr;32(2):790-795. doi: 10.1053/j.jvca.2017.10.040. Epub 2017 Nov 2.


Objective: To investigate the feasibility and safety of using a laryngeal mask airway (LMA) compared with a cuffed oral endotracheal tube (COETT) for atrial fibrillation (AF) ablation with transesophageal echocardiography (TEE).

Design: Prospective, cohort study.

Setting: A single-center inner-city hospital.

Participants: The study comprised adult patients undergoing elective AF ablation with periprocedural TEE over a 3-year period.

Interventions: Patients were treated with either an LMA or a COETT before undergoing a standardized protocol for TEE and AF ablation.

Measurements and main results: The primary outcome was the need for conversion from an LMA to a COETT. Between January 2014 and January 2017, 346 patients underwent AF ablation. Of those, 126 procedures were performed with a COETT (36.4%) and 220 (63.6%) with an LMA. There were no differences between groups in terms of baseline characteristics, including age, sex, body mass index, and American Society of Anesthesiologists grade. An adequate airway seal was unable to be maintained in 3 patients in the LMA group (1.4%), and those patients were converted to a COETT. No episodes of airway complications occurred in either group. No difference was found in mean propofol (2%) dose between COETT and LMA (385 mg/h v 374 mg/h; p = 0.127). However, the mean remifentanil dose (100 µg/mL) was reduced significantly in the LMA group compared with the COETT group at 355 µg/h and 939 µg/h, respectively (p < 0.001).

Conclusions: LMA use is safe and feasible in the vast majority of patients undergoing AF ablation with TEE and is an acceptable alternative to COETT. A significantly reduced rate of remifentanil was required to maintain anesthesia in the LMA group.

Keywords: ablation; echocardiography; laryngeal mask airway.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Analgesics, Opioid / administration & dosage
  • Atrial Fibrillation / diagnostic imaging
  • Atrial Fibrillation / surgery*
  • Cohort Studies
  • Echocardiography, Transesophageal / adverse effects
  • Echocardiography, Transesophageal / methods*
  • Echocardiography, Transesophageal / standards*
  • Female
  • Humans
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / methods
  • Intubation, Intratracheal / standards
  • Laryngeal Masks / adverse effects
  • Laryngeal Masks / standards*
  • Male
  • Middle Aged
  • Pain, Postoperative / diagnostic imaging
  • Pain, Postoperative / physiopathology
  • Prospective Studies


  • Analgesics, Opioid