PFA Under Deep Sedation and Non-Invasive Monitoring in Atrial Fibrillation Patients With Obstructive Sleep Apnea

Clinical data about pulsed field ablation (PFA) under deep sedation among patients with obstructive sleep apnea (OSA) are limited, while the optimal periprocedural monitoring is not established. We report our experience in PFA among patients with atrial fibrillation (AF) and OSA, using a continuous non-invasive respiratory and hemodynamic monitoring protocol.

A total of 32 patients with AF suffering from OSA (mean age 68.5 ±9 years, 31% female) were compared with 60 consecutive patients without OSA. The monitoring protocol comprised continuous beat-to-beat blood pressure recording via an infrared light system and near-infrared spectroscopy for both cerebral and peripheral tissue oximetry. The Acumen Hypotension Prediction Index (HPI) that detects hypotensive trending was also assessed.

Three of the patients with OSA (9%) and four of the controls (6%) developed transient decrease of cerebral saturation during induction to deep sedation, early detected and effectively managed with airway manoeuvres and supplemental oxygen up-titration. In nine patients with OSA (28%) and twenty controls (33%), increased HPI values followed by transient decrease in blood pressure were detected after induction to sedation and/or during PFA, responsive to intravenous fluids. The average time of hypotension was comparable between patients with and without OSA (2.69% vs. 3.23% of the total procedure time, respectively). No serious complications occurred.

PFA under deep sedation in patients with OSA and AF was not associated with higher incidence of adverse events compared to those without OSA. This is confirmed by a sensitive continuous non-invasive monitoring protocol, which could be further evaluated by dedicated multicenter studies.