Sedation Strategies, Drugs, and Protocols Used in Catheter Ablation of Atrial Fibrillation: A Focused Review

Catheter ablation is the mainstay of rhythm control in atrial fibrillation (AF), and its use is steadily increasing worldwide. To optimize procedural safety and efficacy, an appropriate sedation or anesthesia regimen is essential, ensuring adequate analgesia and a stable respiratory pattern while minimizing patient movement. However, the optimal sedation strategy remains a matter of debate, with approaches ranging from general anesthesia to deep or conscious sedation. Since anesthesiologists administer general anesthesia, attention focuses on hypnotics, defined as drugs that induce and/or maintain sleep by depressing the central nervous system, and analgesics. In many centers, these agents are administered by electrophysiology laboratory staff in accordance with local regulations and institutional protocols, which vary among countries. This warrants caution, as individual responses to commonly combined agents are unpredictable and may result in deeper-than-intended sedation. Therefore, respiratory or hemodynamic support may become necessary in selected patients. Notably, protocols incorporating hypnotic communication have also been proposed and implemented. The selection of sedation and analgesia strategies for AF ablation has become increasingly important for balancing patient safety, procedural effectiveness, and resource utilization. The approach should be individualized based on patient characteristics, procedural complexity, energy source, institutional resources, and the relevant national regulatory framework.