Positionspapier der Deutschen Gesellschaft für Kardiologie zur Kardioanalgosedierung

Tilz, Roland Richard; Chun, Julian; Deneke, Thomas; Kelm, Malte; Piorkowski, Christopher; Sommer, Philipp; Stellbrink, Christoph; Steven, Daniel

doi:10.1007/s12181-017-0179-4

Cited by 33 publications

(23 citation statements)

References 39 publications

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“…All procedures were performed with the use of analgosedation using midazolam, fentanyl, and propofol [17]. A 10-pole diagnostic catheter (Webster 1 CS Uni-Directional, Biosense Webster, Inc., Diamond Bar, CA, USA) was positioned within the coronary sinus.…”

Section: Cryoballoon Ablation Proceduresmentioning

confidence: 99%

Mechanism, underlying substrate and predictors of atrial tachycardia following atrial fibrillation ablation using the second-generation cryoballoon

Lyan

Yalın

Abdin

et al. 2019

Journal of Cardiology

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Background: Data regarding atrial tachycardia (AT) following second-generation cryoballoon ablation (CBA) of atrial fibrillation (AF) are limited. Aim: To describe the incidence, mechanisms, and clinical predictors of ATs following CBA. Methods and results: In this retrospective single-center study 238 patients undergoing CBA for treatment of paroxysmal (91/238; 38.2%) or persistent AF were analyzed. During a mean follow-up of 11.9 AE 5.5 months recurrence of AF occurred in 49/238 patients (20.6%) and AT in 27/238 (11.3%). Twenty-six patients with AT and 14 with AF only underwent a redo ablation. The prevailing mechanism of AT was macroreentry [typical atrial flutter (AFL) (n = 10), left atrial macroreentry (n = 14), focal left-AT (n = 2)]. Non-cavotricuspid-isthmus-dependent macroreentry right-AT was mapped and ablated in 3 patients after initial AFL ablation. In a multivariate regression model, persistent type of AF (HR = 3.3; CI = 1.2-9.4), cardiomyopathy (HR = 3.5; CI = 1.5-8.4), treatment with beta-blockers (HR = 0.3; CI = 0.1-0.6), and pulmonary vein-abnormality (HR = 4.6; CI = 2.1-10.4) were independent predictors of AT. Substrate analysis revealed a significantly higher number of low voltage areas in the left atrium in patients with left-AT in comparison to patients with AF recurrence only (2.0; IQR=2.0À4.0 vs. 0.5; IQR = 0.0-2.25; p = 0.005). Conclusion:In this study, AT after CBA occurred in 11.3% of patients with macroreentry being the prevalent mechanism. All patients with left-AT presented with low voltage areas in the left atrium, suggesting a more progressive underlying fibrotic disease in these patients.

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Section: Cryoballoon Ablation Proceduresmentioning

confidence: 99%

Mechanism, underlying substrate and predictors of atrial tachycardia following atrial fibrillation ablation using the second-generation cryoballoon

Lyan

Yalın

Abdin

et al. 2019

Journal of Cardiology

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“…B. Propofol als Sedativum und einem zusätzlichen Analgetikum (z. B. Ketamin) in der Mehrzahl der kardiologischen Zentren bereits seit Jahren klinischer Standard [3] und in den kinderkardiologischen Zentren seit Jahren gelebte Praxis ist [2,[4][5][6]…”

Section: Kinderkardiologische Patienten Tolerieren Diagnostische Und unclassified

“…Tiefe Analgosedierungen (≥Stufe III) erfordern für die Durchführung und Überwachung weitere, entsprechend qualifizierte personelle Unterstützung. Auf das bereits in der Kardiologie als effektiv und sicher etablierte sowie in den meisten kinderkardiologischen Zentren in der klinischen Praxis genutzte Konzept der "nurse-administered propofol sedation" wird ausdrücklich hingewiesen (NAPS, [3,6] Bei Gesundheitspflegern und -pflegerinnen mit Fachweiterbildung Intensivpflege oder Anästhesie oder auch langjährig erfahrenen Pflegern/Pflegerinnen im Bereich Kinderkardiologie bzw. Intensivmedizin kann von diesen erforderlichen Kenntnissen und Erfahrungen ausgegangen werden.…”

Section: Personal Und Zuständigkeitunclassified

Empfehlungen und Standards für die Analgosedierung kinderkardiologischer Patienten

Bertram

Sauer

Haas³

2019

Monatsschr Kinderheilkd

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“…midazolam, bolus and continuous propofol administration by a nurse under the supervision and instructions of the operator or a second electrophysiologist. To obtain analgesia in otherwise painful procedures opioids such as fentanyl or remifentanil is administered additionally [5][6][7]. To guarantee a safe sedation invasive or non-invasive blood pressure (BP), oxygen saturation by pulse oximetry (SpO 2 ) and electrocardiogram including heart rate are monitored.…”

Section: Introductionmentioning

confidence: 99%

Continuous transcutaneous carbon-dioxide monitoring to avoid hypercapnia in complex catheter ablations under conscious sedation

Weinmann

Lenz

Heudorfer

et al. 2021

International Journal of Cardiology

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Background: Ablation of complex cardiac arrhythmias requires an immobilized patient. For a successful and safe intervention and for patient comfort, this can be achieved by conscious sedation. Administered sedatives and analgesics have respiratory depressant side effects and require close monitoring. We investigated the feasibility and accuracy of additional, continuous transcutaneous carbon-dioxide partial pressure (tpCO 2 ) measurement during conscious sedation in complex electrophysiological catheter ablation procedures. Method: We evaluated the accuracy and additional value of continuous tpCO 2 detection by application of a Severinghaus electrode in comparison to arterial and venous blood gas analyses. Results: We included 110 patients in this prospective observational study. Arterial pCO 2 (paCO 2 ) and tpCO 2 showed good correlation throughout the procedures (r = 0.60-0.87, p < 0.005). Venous pCO 2 (pvCO 2 ) were also well correlated to transcutaneous values (r = 0.65-0.85, p < 0.0001). Analyses of the difference of pvCO 2 and tpCO 2 measurements showed a tolerance within <10 mmHg in up to 96-98% of patients. Hypercapnia (pCO 2 < 70 mmHg) was detected more likely and earlier by continuous tpCO 2 monitoring compared to halfhourly pvCO 2 measurements. Conclusion: Continuous tpCO 2 monitoring is feasible and precise with good correlation to arterial and venous blood gas carbon-dioxide analysis during complex catheter ablations under conscious sedation and may contribute to additional safety.

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Positionspapier der Deutschen Gesellschaft für Kardiologie zur Kardioanalgosedierung

Cited by 33 publications

References 39 publications

Mechanism, underlying substrate and predictors of atrial tachycardia following atrial fibrillation ablation using the second-generation cryoballoon

Mechanism, underlying substrate and predictors of atrial tachycardia following atrial fibrillation ablation using the second-generation cryoballoon

Empfehlungen und Standards für die Analgosedierung kinderkardiologischer Patienten

Continuous transcutaneous carbon-dioxide monitoring to avoid hypercapnia in complex catheter ablations under conscious sedation

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