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Related Concept Videos

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Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
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Impact of a balloon-in-basket pulsed field ablation catheter on oesophageal temperature changes during pulmonary vein isolation.

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"Awake and Ablated": First experience with a balloon-in-basket PFA system without propofol.

Roland Richard Tilz1,2, Jan-Per Wenzel1,2, Charlotte Eitel1

  • 1University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany.

Heart Rhythm O2
|February 25, 2026
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Summary

Pulsed field ablation (PFA) using the balloon-in-basket system under conscious sedation is safe and feasible for pulmonary vein isolation. This approach leads to high patient satisfaction and streamlines procedures.

Keywords:
Atrial fibrillationBalloon-in-basket catheterConscious sedationPatient-reported outcomesPulmonary vein isolationPulsed field ablation

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Pulsed field ablation (PFA) is an emerging technique for pulmonary vein isolation (PVI) in atrial fibrillation.
  • The balloon-in-basket (BiB)-PFA system facilitates circumferential PVI with enhanced tissue contact.
  • Traditional PFA often requires deep sedation or general anesthesia, posing procedural risks and logistical challenges.

Purpose of the Study:

  • To evaluate the safety, feasibility, and patient experience of BiB-PVI performed under conscious sedation.
  • To assess the tolerability of BiB-PVI without routine propofol use.
  • To determine if conscious sedation can maintain patient comfort and procedural success.

Main Methods:

  • Prospective enrollment of consecutive patients undergoing de novo PVI.
  • Conscious sedation protocol involving fentanyl, midazolam, metamizole, and lidocaine; propofol reserved for cardioversion.
  • Patient-reported outcomes including pain, dyspnea, anxiety, satisfaction, and recommendation assessed via questionnaires.

Main Results:

  • 14 patients (86% male, mean age 70.6 years) completed the study.
  • Mean procedure duration was 54.5 minutes, with a mean LA dwell time of 23 minutes.
  • Significant reduction in pain scores post-ablation (P < .002); low dyspnea and anxiety levels reported. High satisfaction (95%) and recommendation (100%) rates observed.

Conclusions:

  • BiB-PFA under conscious sedation is a safe and feasible option for PVI.
  • This approach is well-tolerated by patients, leading to high satisfaction.
  • Conscious sedation with BiB-PFA allows for streamlined procedures and potentially reduced risks associated with deep sedation.