Deep sedation for catheter ablation of atrial fibrillation: a prospective study in 650 consecutive patients

Catheter ablation of atrial fibrillation (AF) is a highly invasive and relatively long-lasting procedure with specific requirements for patient sedation. The feasibility and safety of deep sedation is described in a prospective study of 650 consecutive patients.

Sedation was initiated with an intravenous (iv) bolus of midazolam, and analgesia with an iv fentanyl bolus. After an iv propofol bolus, maintenance of sedation was achieved with continuous iv administration of propofol with a guide dose of 5 mg per kg per hour. Heart rate, invasive arterial blood pressure, and oxygenation were continuously monitored. The administration of sedation and analgesia medication were performed by a nurse under the supervision and instructions of the electrophysiologist.

The mean dose of the initial midazolam bolus was 2.4 ± 0.7 mg and of the initial propofol bolus 32 ± 11 mg. The beginning dose of continuous propofol infusion was 352 ± 66 mg/h; titration to the desired effect of deep sedation required adjustment on an average of 3.8 ± 2.6 times leading to a maintenance dose of continuous propofol infusion of 399 ± 99 mg/h. No major sedation-related complications were observed. Endotracheal intubation was necessary in none of the patients. Heart rate, invasive arterial blood pressure, and oxygenation remained stable during sedation.

Deep sedation for catheter ablation of AF is feasible and safe. Especially, the goal of keeping the patient in deep sedation while maintaining spontaneous ventilation and cardiovascular hemodynamic stability was accomplished. Endotracheal intubation or consultation of an anesthesiologist was not necessary in any patient.