Impact of Body Weight on Sedation-Related Outcomes in Complex Electrophysiological Interventions

Higher body mass index (BMI) is associated with a greater burden of cardiometabolic comorbidities that may potentially increase the risk of sedation-related complications. However, the impact of BMI on sedation safety during complex electrophysiological procedures (CEPs) remains uncertain.

In this study conducted at Ulm University Heart Center, patients undergoing CEPs were stratified into three BMI groups: normal weight, overweight, and obesity. Primary and secondary endpoints were analyzed using univariable and multivariable logistic regression analyses. The primary composite endpoint (PCE) was the occurrence of sedation-related complications, defined as oxygen saturation below 90% combined with abnormal peripheral venous blood gas results-specifically, a venous carbon dioxide level exceeding 70 mmHg, an increase of more than 30% from baseline, or a pH drop below 7.25. Secondary endpoints included sedative and opioid requirements as well as occurrence of individual components of the PCE.

A total of 726 patients were included, with 299 (42.3%) being female. The study population comprised 236 patients (32.5%) of normal weight, 265 (36.5%) overweight, and 225 (31.0%) obese. Patients with higher BMI presented with a greater burden of comorbidities and lower baseline oxygen saturation at the start of the procedure. While absolute sedative and opioid doses remained stable or even increased with BMI, relative doses (mg/kg) were higher in normal-weight patients. No significant differences were observed between BMI groups for either the primary or secondary endpoints. Female sex emerged as an independent predictor of adverse sedation events, with a higher incidence of reaching the PCE (p = 0.046, OR 1.411).

BMI alone was not associated with an increased risk of sedation-related complications during CEPs. Despite higher absolute drug requirements and a greater comorbidity burden in overweight and obese patients, procedural safety was comparable across all BMI categories. These findings emphasize that individualized sedation protocols, embedded within standardized monitoring frameworks, are essential to ensure safe and effective sedation in diverse patient populations.