Safety of ventricular tachycardia ablation under deep sedation with propofol and fentanyl

There is no current standard of anaesthetic management for CA of VT. Data on VT ablation under deep sedation with propofol and fentanyl are limited.

The aim was to evaluate the feasibility and safety of CA of VT under deep sedation with propofol and fentanyl.

Data from 134 procedures in 106 patients undergoing CA for VT under sedation with propofol and fentanyl were prospectively included. Three groups were defined and compared: group 1 (no VT induction, n=36); group 2 (induction of hemodynamically unstable VT, n=42), and group 3 (induction of hemodynamically stable VT, n=56).

Median age was 64 years, 84% were male, and 97% had structural heart disease. Group 2 had a higher proportion of patients with DCM (p=0.04) and severely reduced LVEF (p=0.024). Unipolar RF ablation was performed in 95% of procedures, bipolar in 12%, and alcohol ablation in 4%. Epicardial access was utilized in 18%. Radiation dose was higher in group 2 (p=0.04), while post-ablation non-inducibility was more frequently achieved in group 3 (p=0.045). There were no cases of profound hypotension or intubation associated with sedation. CPR was performed in seven procedures due to PEA, all in group 2 (p<0.001) with ROSC achieved in all cases within 3 min. No differences were observed in complication rates or hospital stay.

CA for VT under deep sedation with propofol and fentanyl in patients with structural heart disease is feasible and safe, irrespective of VT induction, mapping, and ablation approach. Hemodynamic instability, hypotension, and desaturation can be effectively managed.