Safety and feasibility of trans‐venous cardiac device extraction using conscious sedation alone—Implications for the post‐COVID‐19 era

Lachlan, Thomas; He, Hejie; Aggour, Hesham; Sahota, Preet Kaur; Harvey, Samuel B.; Patel, Kiran; Foster, Will; Yusuf, Shamil; Panikker, Sandeep; Dhanjal, Tarvinder; Dandekar, Uday; Barker, Thomas; Parmar, Jitendra; Kuehl, Michael; Osman, Faizel

doi:10.1002/joa3.12637

Cited by 1 publication

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“…In contrast, patients under deep sedation (DS) will respond purposefully to repeated and painful stimuli, normally without the need for intubation [10]. TLE under conscious sedation (lighter than deep sedation, patients who purposefully respond to verbal or tactile stimulation) alone with diazepam and/or midazolam has been shown to be feasible [11]. DS is common in many other invasive interventions, such as ablation of atrial fibrillation, and has been shown to be safe and feasible [12].…”

Section: Introductionmentioning

confidence: 99%

Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis

Bock,

O’Connor,

Chouchane

et al. 2023

JCM

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Background: The demand for transvenous lead extraction (TLE) has increased. In line with this, the safety of such procedures has also increased. Traditionally, TLE is performed under resource-intensive general anaesthesia. This study aims to evaluate the safety and outcomes of Cardiologist-lead deep sedation for TLE. Methods: We retrospectively analysed 328 TLE procedures performed under deep sedation from 2016 to 2019. TLE procedures were performed by experienced electrophysiologists. Sedation was administered by a specifically trained cardiologist (bolus midazolam/fentanyl and propofol infusion). Procedural sedation data including blood pressure, medication administration and sedation time were collected. Complications related to sedation and the operative component of the procedure were analysed retrospectively. Results: The sedation-associated complication rate during TLE was 22.0%. The most common complication (75% of complications) was hypotension requiring noradrenaline, followed by bradycardia requiring atropine (13% of complications). Additionally, the unplanned presence of an anaesthesiologist was needed in one case (0.3%). Deep sedation was achieved with midazolam (mean dose 42.9 ± 26.5 µg/kg), fentanyl (mean dose 0.4 ± 0.6 µg/kg) and propofol (mean dose 3.5 ± 1.2 mg/kg/h). There was no difference in medication dosage between those with a sedation-associated complication and those without. Sedation-associated complications appeared significantly more in patients with reduced LVEF (p = 0.01), renal impairment (p = 0.01) and a higher American Society of Anaesthesiologists (ASA) class (p = 0.01). Conclusion: Deep sedation for TLE can be safely performed by a specifically trained cardiologist, with a transition to general anaesthesia required in only 0.3% of cases. We continue to recommend the on-call availability of an anaesthesiologist and cardiac surgeon in case of major complications.

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Section: Introductionmentioning

confidence: 99%

Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis

Bock,

O’Connor,

Chouchane

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

Safety and feasibility of trans‐venous cardiac device extraction using conscious sedation alone—Implications for the post‐COVID‐19 era

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 1 publication

References 24 publications

Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis

Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis

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