Simple minimal sedation for catheter ablation of atrial fibrillation

Deep sedation or general anesthesia is generally used during atrial fibrillation (AF) ablation. The aim of this study was to report the safety and feasibility of minimal sedation during AF ablation.

One thousand and fifty-two AF ablation procedures in 819 patients (62 ± 11 years, 621 men, 506 paroxysmal) were included. Boluses of intravenous hydroxyzine pamoate and pentazocine were administered, with a maximal dose of 100 mg of hydroxyzine and 60 mg of pentazocine in response to pain. If the pain was intolerable or patients requested deeper sedation, moderate sedation using dexmedetomidine or propofol was introduced. Among 819 consecutive first procedures, the procedure was completed under minimal sedation in 795 (97.1%) patients without inotropic drugs or respiratory support, whereas in 20 (2.4%) patients, anesthesia was switched to moderate sedation due to pain. Patients requiring a switch to moderate sedation were significantly younger than those without (53.6 ± 2.3 vs. 62.6 ± 10.4, P<0.01). No procedures were abandoned due to adverse effects of sedation. Significant intra-procedural blood pressure decreases requiring inotropic drugs were not observed in any patients. Among 233 patients who underwent repeat procedures, 6 (2.6%) requested moderate sedation before the procedure. The mean procedure time was 151 ± 54 min. Cardiac tamponade, unrelated to sedation, was observed in 7 (0.66%) procedures.

Minimal sedation might be acceptable anesthesia in the vast majority of AF ablation procedures performed in electrophysiological laboratories.