Safety Aspects of Deep Sedation during Catheter Ablation of Atrial Fibrillation

Wutzler, Alexander; Rolf, Sascha; Huemer, Martin; Parwani, Abdul Shokor; Boldt, Leif‐Hendrik; Herberger, Erik; Hohenbichler, Katharina; Dietz, Rainer; Haverkamp, Wilhelm

doi:10.1111/j.1540-8159.2011.03260.x

Cited by 37 publications

(32 citation statements)

References 27 publications

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“…Haemodynamic and oxygenation changes during anaesthesia stayed within the ranges of previous studies [15]. No case of severe or prolonged haemodynamic or respiratory instability due to sedation occurred.…”

Section: Resultssupporting

confidence: 73%

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Contact force mapping during catheter ablation for atrial fibrillation: procedural data and one-year follow-up

Wutzler

Huemer

Parwani

et al. 2014

aoms

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IntroductionPulmonary vein isolation (PVI) is the state-of-the-art treatment of atrial fibrillation (AF). Pulmonary vein reconnection is one of the main mechanisms of AF recurrence after ablation. Catheter-tissue contact is essential for effective ablation lesions. The aim of this study was to evaluate the impact of catheter contact monitoring during PVI on AF recurrence rate.Material and methodsOne hundred and forty-three patients who underwent PVI were analysed. In 31 patients, PVI was performed by monitoring the catheter-tissue contact with a contact force (CF) sensing catheter. One hundred and twelve patients in whom conventional PVI was performed without CF information served as the control group. Procedural data and recurrence rate within 12-month follow-up were compared.ResultsA significant reduction in procedure duration was seen in the CF mapping group (128.4 ±29 min vs. 157.7 ±30.8 min, p = 0.001). Complete pulmonary vein isolation was achieved in 100% of the patients. Rate of AF recurrence within 12 months after ablation was significantly lower in the contact force group (16.1%) when compared to the standard ablation group (36.6%) (p = 0.031).ConclusionsPulmonary vein isolation with the use of contact force information results in a shorter procedure duration and a lower rate of AF recurrence after 12 months compared to conventional PVI without this information. Catheter-tissue contact monitoring may have a beneficial effect on mid-term and long-term results of PVI procedures.

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Section: Resultssupporting

confidence: 73%

“…Procedures were performed as described previously [15]. Patients were in a fasting state, and transoesophageal echocardiography was performed prior to the ablation to rule out a left atrial thrombus.…”

Section: Methodsmentioning

confidence: 99%

Contact force mapping during catheter ablation for atrial fibrillation: procedural data and one-year follow-up

Wutzler

Huemer

Parwani

et al. 2014

aoms

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“…However, heart movement and desaturation caused by unstable respiration with considerable respiratory variations and airway obstruction due to a retracted tongue root are the main problems during the procedure. To avoid these issues, some studies recommended assisted ventilation or an anesthetist in immediate attendance during the procedures [6], [17], [18], [19]. However, these services require money, time, and the support of an anesthesiologist, and not all institutions can afford these preparations.…”

Section: Discussionmentioning

confidence: 99%

Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation

Takigawa

Takahashi

Kuwahara

et al. 2017

Journal of Arrhythmia

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BackgroundThe present study aimed to elucidate the safety and effectiveness of a noble and unique airway management technique in which a pediatric intubation tube is used in adult patients with atrial fibrillation (AF) undergoing catheter ablation (CA) under continuous deep sedation.MethodsIn total, 246 consecutive patients with AF (mean age, 65±10 years; 60 women) underwent CA under dexmedetomidine-based continuous deep sedation. A 4-mm pediatric intubation tube guided by a 10-French intratracheal suction tube was inserted smoothly, and the tip of the tube was located at the base of the epiglottis. The maximum shifting distance of the heart (MSDH) was measured with the 3D mapping system (Ensite NavX system) before and after inserting the pediatric intubation tube.ResultsAt baseline, the MSDH of patients under continuous deep sedation was 23±14 mm. The pediatric intubation tube reduced the MSDH to 13±6 mm (mean reduction from baseline, 38.4±21.7%; P<0.0001). In contrast, oxygen saturation was significantly increased from 89±8% to 95±3% (P<0.0001). The mean distance between the nostril and base of the epiglottis was 16.6±0.5 mm. Major periprocedural complications occurred in 9 (3.6%) patients including 3 (1.2%) cardiac tamponade and 6 (2.4%) phrenic nerve injury cases. Larger MSDH (odds ratio, 1.13; 95% confidence interval, 1.04–1.25; P=0.007) was a significant predictor of major periprocedural complications. No major airway complications occurred, except in 3 patients (1.2%) who had minor nasal bleeding.ConclusionThis unique airway management technique using a pediatric intubation tube for CA procedures performed in adult patients with AF under continuous deep sedation was easy, safe, and effective.

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“…Nevertheless, the degree of pain relief for patients with AF undergoing RFA depends on the practices of each hospital's electrophysiology centre. Both general anaesthesia and conscious sedation are used (Carnlof, Insulander, & Jensen-Urstad, 2014;Norgaard et al, 2013;Wutzler et al, 2012).The European Association for Palliative Care suggested Oxycodone as one alternative to morphine in 2001, but at the time, in many countries, Oxycodone was still considered as a step II opioid, or as a constituent of compound preparations with a non-opioid analgesic. Since that time, use of Oxycodone has increased significantly in many countries and it has become one of the most prescribed opioids in the United States (King, Reid, Forbes, & Hanks, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…Combinations of oxycodone and Paracetamol have a double central analgesic mechanism of action and induce rapid pain relief (Gatti et al, 2010). No gold standard exists for conscious pain management during RFA in patients with AF, but some studies have assessed deep sedation with propofol in patients undergoing RFA for AF (Wutzler et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Premedication and preoperative information reduces pain intensity and increases satisfaction in patients undergoing ablation for atrial fibrillation. A randomised controlled study

Al-Azawy

Oterhals

Fridlund

et al. 2015

Applied Nursing Research

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Safety Aspects of Deep Sedation during Catheter Ablation of Atrial Fibrillation

Cited by 37 publications

References 27 publications

Contact force mapping during catheter ablation for atrial fibrillation: procedural data and one-year follow-up

Contact force mapping during catheter ablation for atrial fibrillation: procedural data and one-year follow-up

Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation

Premedication and preoperative information reduces pain intensity and increases satisfaction in patients undergoing ablation for atrial fibrillation. A randomised controlled study

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