Reliability of Noninvasive Blood Pressure Monitoring During Atrial Fibrillation Ablation Under General Anesthesia

Jonathon Schwartz; Mohammed Al-Sadawi; Daniel Mattimore; Abhijeet Singh; Andreas Kalogeropoulos

doi:10.1053/j.jvca.2026.03.003

Reliability of Noninvasive Blood Pressure Monitoring During Atrial Fibrillation Ablation Under General Anesthesia

J Cardiothorac Vasc Anesth. 2026 Mar 6:S1053-0770(26)00201-6. doi: 10.1053/j.jvca.2026.03.003. Online ahead of print.

Authors

Jonathon Schwartz¹, Mohammed Al-Sadawi², Daniel Mattimore³, Abhijeet Singh², Andreas Kalogeropoulos²

Affiliations

¹ Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY. Electronic address: Jonathon.schwartz@stonybrookmedicine.edu.
² Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY.
³ Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY.

PMID: 41904065
DOI: 10.1053/j.jvca.2026.03.003

Abstract

Objectives: To evaluate the accuracy and reliability of noninvasive blood pressure (NIBP) monitoring compared to invasive blood pressure (IBP) measurements during atrial fibrillation (AF) ablation under general anesthesia, and to determine whether cardiac rhythm influences NIBP performance.

Design: A retrospective observational cohort study.

Setting: A tertiary academic medical center.

Participants: Ninety adult patients undergoing endovascular AF ablation between June 2022 and March 2023, with paired NIBP and IBP measurements recorded during both sinus rhythm and AF.

Interventions: No interventions were administered for study purposes. All patients received standard general anesthesia and intraoperative monitoring, including radial arterial catheter placement and oscillometric NIBP cuff measurements.

Measurements and main results: A total of 1,158 paired NIBP-IBP measurements were analyzed. NIBP underestimated systolic BP by 3.5 mmHg and overestimated diastolic and mean arterial pressures by 2.3 mmHg and 1.4 mmHg, respectively (all p < 0.05). Within-subject variability was highest for systolic BP (SD = 12.3 mmHg). Cardiac rhythm did not significantly affect agreement, though AF and paced rhythm were associated with increased systolic error in univariate models. Ventilation mode and vasopressor use also influenced discrepancies. Intraclass correlation coefficients ranged from 0.73 to 0.84 across BP types.

Conclusions: While rhythm did not significantly alter NIBP reliability, substantial variability-particularly in systolic measurements-limits its interchangeability with IBP during AF ablation. These findings support cautious use of NIBP in high-risk procedural settings and highlight the need for further validation in special populations.

Keywords: atrial fibrillation; endovascular arrhythmia ablation; general anesthesia; invasive blood pressure; non-invasive blood pressure; oscillometric blood pressure; perioperative monitoring.