Minimal and deep sedation during ablation of ventricular tachycardia

Wutzler, Alexander; Mueller, Amélie; Loehr, Lena; Huemer, Martin; Parwani, Abdul Shokor; Attanasio, Philipp; Blaschke, Florian; Storm, Christian; Boldt, Leif‐Hendrik; Haverkamp, Wilhelm

doi:10.1016/j.ijcard.2013.12.175

Cited by 20 publications

(12 citation statements)

References 17 publications

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“…Several studies have investigated the safety of propofol in various ICU cardiology settings, with results indicating that propofol is a safe and effective drug, which aligns with the findings of this study. 31,38–40 A concern is the narrow therapeutic window of propofol, and the infusion of propofol for deep sedation should only be used during careful hemodynamic monitoring. 33,40 Worldwide, catheter ablation in VT is performed with increasing frequency.…”

Section: Discussionmentioning

confidence: 99%

Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm

Bundgaard¹,

Jacobsen²,

Grand³

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background: Electrical storm and incessant ventricular tachycardia (VT) are characterized by the clustering of episodes of VT or ventricular fibrillation (VF) and are associated with a poor prognosis. Autonomic nervous system activity influences VT threshold, and deep sedation may be useful for the treatment of VT emergencies. Methods: We reviewed data from conscious patients admitted to our intensive care unit (ICU) due to monomorphic VT, polymorphic VT or VF at our tertiary center between 2010 and 2018. Results: A total of 46 conscious patients with recurrent ventricular arrhythmia, refractory to initial treatment, were referred to the ICU. The majority ( n = 31) were stabilized on usual care. The remaining treatment-refractory 15 patients (57 years (range 9–74), 80% males, seven with implantable cardioverter-defibrillators) with VT/VF storm ( n = 11) or incessant VT ( n = 4) due to ischemic heart disease ( n = 10), cardiomyopathy ( n = 2), primary arrhythmia ( n = 2) and one patient post valve surgery, were deeply sedated and intubated. A complete resolution of VT/VF within minutes to hours was achieved in 12 patients (80%), partial resolution in two (13%) and one (7%) patient died due to ventricular free-wall rupture. One patient with recurrent VT episodes needing repeated deep sedation developed necrotic caecum. No other major complications were seen. Thirteen (87%) patients were alive after a mean follow-up of 3.7 years. Conclusion: Deep sedation was effective and safe for the temporary management of malignant VT/VF refractory to usual treatment. In emergencies, deep sedation may be widely accessible at both secondary and tertiary centers and a clinically useful bridge to definitive treatment of VT.

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Section: Discussionmentioning

confidence: 99%

Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm

Bundgaard¹,

Jacobsen²,

Grand³

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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“…In total, 79 patients who underwent ablation for presumed AVNRT, aged < 19 6–18 years, were included in the study. The criteria for presumed AVNRT were defined as ECG‐documented tachycardia that had a narrow QRS with unclear P waves, which could not be distinguished, and could not be induced during EPS, with the exclusion of other probable accessory pathways.…”

Section: Methodsmentioning

confidence: 99%

Empiric slow‐pathway ablation results for presumed atrioventricular nodal reentrant tachycardia in pediatric patients

Duman

Ertuğrul

Baştuhan

et al. 2021

Pacing Clinical Electrophis

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Background In pediatric patients with documented narrow QRS tachycardia that is suggestive of atrioventricular nodal reentrant tachycardia (AVNRT) and not inducible in electrophysiological study (EPS), empiric slowpathway ablation (ESPA) may be considered. There is limited data in children about this topic. Methods Seventy‐nine patients who underwent cryoablation and/or radiofrequency ablation (RFA) for presumed AVNRT between January 2010 and January 2020, with no inducible tachycardia and no other tachycardia mechanisms during EPS, were included in this study. Results The age was between 6 and 18 years. All patients had no structural heart disease. Preablation exhibited sustained SP conduction for all patients. In all cases, the ablation end points were prolongation in wenckebach cycle length (WBCL) with loss of cross and/or jump, and/or echo beat. The end points were not achieved in two patients. Overall, the mean basal WBCL increased to 351 ms (240‐500 ms) from 301.3 ms (180‐420 ms), evident in the non‐recurrence group. Nine patients had a transient AV block that improved. We followed the patients without medication for about 46.9 months (8 months to 10 years). Palpitations occurred again in 9 of 77 patients (clinical recurrence rate 9/79 – 11.3%). The documented ECG recurrence rate was 1.2% (1/79). In the non‐recurrence group, WBCL prolongation was higher and mean age was lower than in the recurrence group (13.075 vs. 15.33 years). Conclusion In cases with presumed AVNRT, ESPA seems to be a reasonable and safe way. In our study, we found our procedural success rate as 97.4% and follow‐up recurrence rate as 12.6% (9+1/79).

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“…14 In a previous study of patients who had ventricular tachycardia ablation, there was no significant difference in complication rate between minimal and deep sedation. 15 Also, in another study, patients undergoing percutaneous epicardial access (for ventricular tachycardia or premature ventricular complex) had similar complication rates regardless of whether they did the procedure under general anesthesia or moderate/deep sedation. 16 Furthermore, in a study by Tang et al, patients who underwent nonconscious sedation during catheter ablation for atrial fibrillation had more transient anesthetic complications as compared with conscious sedation.…”

mentioning

confidence: 93%

“…However, it should be noted that conscious sedation does carry a risk of hypoventilation and aspiration 14 . In a previous study of patients who had ventricular tachycardia ablation, there was no significant difference in complication rate between minimal and deep sedation 15 . Also, in another study, patients undergoing percutaneous epicardial access (for ventricular tachycardia or premature ventricular complex) had similar complication rates regardless of whether they did the procedure under general anesthesia or moderate/deep sedation 16 .…”

mentioning

confidence: 99%

Patients' experience after cryoballoon ablation under moderate sedation and general anesthesia

Jalloul

Refaat

2020

Cardiovasc electrophysiol

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Minimal and deep sedation during ablation of ventricular tachycardia

Cited by 20 publications

References 17 publications

Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm

Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm

Empiric slow‐pathway ablation results for presumed atrioventricular nodal reentrant tachycardia in pediatric patients

Patients' experience after cryoballoon ablation under moderate sedation and general anesthesia

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