Dexmedetomidine versus propofol for operator-directed nurse-administered procedural sedation during catheter ablation of atrial fibrillation: A randomized controlled study

Servatius, Helge; Kueffer, Thomas; Baldinger, Samuel H.; Asatryan, Babken; Seiler, Jens; Tanner, Hildegard; Novák, Jan; Lam, Anna; Noti, Fabian; Haeberlin, Andreas; Madaffari, Antonio; Sweda, Romy; Mühl, Aline; Branca, Mattia; Dütschler, Sophie; Erdoes, Gabor; Stüber, Frank; Theiler, Lorenz; Reichlin, Tobias; Roten, Laurent

doi:10.1016/j.hrthm.2021.12.028

Cited by 23 publications

(16 citation statements)

References 24 publications

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“…We used propofol, fentanyl and midazolam for deep sedation in three cases 6 and general anesthesia in two. After obtaining femoral venous access and placing a decapolar catheter in the coronary sinus, we accessed the left atrium by fluoroscopy‐guided transseptal puncture or via a patent foramen ovale.…”

Section: Methodsmentioning

confidence: 99%

Pulsed‐field‐ablation for the treatment of atrial fibrillation in patients with congenital anomalies of cardiac veins

Castiglione

Kueffer

Gräni

et al. 2023

Cardiovasc electrophysiol

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Introduction: Anomalous cardiac veins are not rare and pulmonary vein (PV) isolation for atrial fibrillation (AF) treatment should include these veins. Pulsed-field ablation (PFA) is a novel technology for AF ablation with excellent efficacy and safety profile.In this case series, we describe our first experience of isolation of anomalous cardiac veins using PFA in patients with AF.Methods: We report a series of patients with congenital anomalies of the cardiac veins and AF, treated with PFA. All patients underwent cardiac computed tomography for procedural planning.Results: We included five patients (four males). Anomalous cardiac veins included a connection of a left common ostium to the coronary sinus, a partial and complete drainage of the right superior PV into the superior vena cava (SVC) with and without additional atrial septal defect, a persistent left SVC and an anomalous posterior PV.All anomalous PVs were isolated using PFA. No phrenic nerve palsy or other complications occurred. PFA of an abnormal right superior PV draining into the distal SVC was possible without affecting the sinus node. After a median of 4 months, four patients were free of recurrence. One patient had recurrent AF and perimitral reentry tachycardia, probably facilitated by PFA in the mitral isthmus region during isolation of an anomalous connection of the left common ostium to the coronary sinus.Conclusions: Using systematic preprocedural imaging and three-dimensionalelectroanatomic mapping, the currently available PFA system seems well suited, efficient, and versatile for the treatment of AF in patients with anomalous cardiac veins.

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Section: Methodsmentioning

confidence: 99%

Pulsed‐field‐ablation for the treatment of atrial fibrillation in patients with congenital anomalies of cardiac veins

Castiglione

Kueffer

Gräni

et al. 2023

Cardiovasc electrophysiol

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“…Prior to the procedure, patients underwent trans-esophageal echocardiography and computed tomography to exclude intracardiac thrombi and to obtain a detailed understanding of the left atrial anatomy. Deep conscious sedation using propofol and fentanyl was used, guided by a physician-led, nurse-administered protocol, while patients with a high risk of sedation complications underwent general anesthesia [ 9 ]. Left atrial access was obtained by fluoroscopy-guided transseptal puncture either using a standard transseptal sheath, followed by an exchange to the 13F Faradrive sheath, or through a direct puncture using the 13F sheath [ 10 ], depending on the physician’s preference.…”

Section: Methodsmentioning

confidence: 99%

Pulmonary vein isolation durability and lesion regression in patients with recurrent arrhythmia after pulsed-field ablation

Kueffer

Stefanova

Madaffari

et al. 2023

J Interv Card Electrophysiol

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Background A novel multipolar pulsed-field ablation (PFA) catheter has recently been introduced for pulmonary vein isolation (PVI). Pre-market data showed high rates for PVI-durability during mandatory remapping studies. Objective: To present post-market data in patients with recurrent arrhythmias. Methods Consecutive patients undergoing a redo procedure after an index PFA PVI using a bipolar-biphasic PFA system were included. 3-D electro-anatomical maps (3D-EAM) on redo procedure were compared to the 3D-EAM acquired after ablation during the index procedure. PVI durability was assessed on a per-vein and per-patient level and the sites of reconnections were identified. Furthermore, lesion extent around veins with durable isolation was compared to study lesion regression. Results Of 341 patients treated with a PFA PVI, 29 (8.5%) underwent a left atrial redo ablation due to arrhythmia recurrence. At the end of the index procedure, 110/112 veins (98%, four common ostia) were isolated. On redo procedures performed a median of 6 months after the first ablation, 3D-EAM identified 69/110 (63%) PVs with durable isolation. In 6 (21%) patients, all PVs were durably isolated. Reconnections were more often found on the right-sided veins and on the anterior aspects of the upper veins. Only minor lesion regression was observed between the index and redo procedure (a median of 3 mm (0 – 9.5) on the posterior wall). Conclusion In patients with arrhythmia recurrence after PFA PVI using a first-generation PFA device, durable isolation was observed in 63% of the veins and 21% of the patients showed durable isolation of all previously isolated veins. Graphical abstract

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“…In patients with underlying heart disease dexmed may cause left ventricular dysfunction [ 21 ]. In a recent study, Servatius et al [ 22 ▪▪ ] compared the effects of propofol vs. dexmedetomidine in 160 patients undergoing radiofrequency catheter ablation. Dexmed was shown not to be superior to propofol in this randomized controlled study.…”

Section: Medicationmentioning

confidence: 99%

“…Dexmed was shown not to be superior to propofol in this randomized controlled study. Hypercapnia occurred less frequent with dexmed, but with propofol the sedation strategy was shown to be efficient in all patients and patient satisfaction was significantly higher [ 22 ▪▪ ].…”

Section: Medicationmentioning

confidence: 99%

Optimization of procedural sedation and analgesia during atrial fibrillation ablation

Homberg

Bouman

Joosten

2023

Current Opinion in Anaesthesiology

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Purpose of reviewThis mini-review is aimed to provide an overview and discuss procedural sedation and analgesia for atrial fibrillation (AF) ablation with focus at qualification of staff, patient evaluation, monitoring, medication and postprocedural care.Recent findingsSleep-disordered breathing is highly prevalent in patients with AF. Impact of often used STOP-BANG questionnaire to detect sleep-disordered breathing in AF patients is limited due to its restricted validity. Dexmedetomidine is a commonly used drug in sedation, but is shown not to be superior to propofol in sedation during AF-ablation. Alternatively use of remimazolam has characteristics that makes it a promising drug for minimal to moderate sedation for AF-ablation. High flow nasal oxygen (HFNO) has shown to reduce the risk of desaturation in adults receiving procedural sedation and analgesia.SummaryAn optimal sedation strategy during AF ablation should be based on AF patient characteristics, the level of sedation needed, the procedure (duration and type of ablation) and the education and experience of the sedation provider. Patient evaluation and post procedural care are part of sedation care. More personalized care based on use of various sedation strategies and types of drugs as related to the type of AF-ablation is the way to further optimize care.

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Dexmedetomidine versus propofol for operator-directed nurse-administered procedural sedation during catheter ablation of atrial fibrillation: A randomized controlled study

Cited by 23 publications

References 24 publications

Pulsed‐field‐ablation for the treatment of atrial fibrillation in patients with congenital anomalies of cardiac veins

Pulsed‐field‐ablation for the treatment of atrial fibrillation in patients with congenital anomalies of cardiac veins

Pulmonary vein isolation durability and lesion regression in patients with recurrent arrhythmia after pulsed-field ablation

Optimization of procedural sedation and analgesia during atrial fibrillation ablation

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