Deep sedation with propofol in patients undergoing left atrial ablation procedures-Is it safe?

Leonie Foerschner; Nada Harfoush; Mara Thoma; Lovis Spitzbauer; Miruna Popa; Felix Bourier; Tilko Reents; Verena Kantenwein; Martha Telishevska; Katharina Wimbauer; Carsten Lennerz; Elena Risse; Amir Brkic; Susanne Maurer; Patrick Blazek; Fabian Bahlke; Christian Grebmer; Christof Kolb; Isabel Deisenhofer; Gabriele Hessling; Marc Kottmaier

doi:10.1016/j.hroo.2022.02.011

Deep sedation with propofol in patients undergoing left atrial ablation procedures-Is it safe?

Heart Rhythm O2. 2022 Feb 22;3(3):288-294. doi: 10.1016/j.hroo.2022.02.011. eCollection 2022 Jun.

Authors

Leonie Foerschner¹, Nada Harfoush¹, Mara Thoma¹, Lovis Spitzbauer¹, Miruna Popa¹, Felix Bourier¹, Tilko Reents¹, Verena Kantenwein¹, Martha Telishevska¹, Katharina Wimbauer¹, Carsten Lennerz¹, Elena Risse¹, Amir Brkic¹, Susanne Maurer¹, Patrick Blazek¹, Fabian Bahlke¹, Christian Grebmer¹, Christof Kolb¹, Isabel Deisenhofer¹, Gabriele Hessling¹, Marc Kottmaier¹

Affiliation

¹ Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Munich, Germany.

Abstract

Background: Catheter ablation for atrial fibrillation (AF) or left atrial tachycardia is well established. To avoid body movement and pain, sedative and analgesic agents are used.

Objective: The aim was to investigate safety of sedation/anti-pain protocol administered by electrophysiology (EP) staff.

Methods: A total of 3211 consecutive patients (61% male) undergoing left atrial ablation for paroxysmal AF (37.1%), persistent AF (35.3%) or left atrial tachycardia (27.6%) were included. Midazolam, fentanyl, and propofol were administered by EP staff. In case of respiratory depression, endotracheal intubation (eIT) or noninvasive ventilation (NIV) was implemented. Risk factors for eIT or NIV were analyzed.

Results: Mean doses of propofol, midazolam, and fentanyl were 33.7 ± 16.7 mg, 3 ± 11.1 mg, and 0.16 ± 2.2 mg, respectively. Norepinephrine was administered in 396 of 3211 patients (12.3%) because of blood pressure drop (mean arterial pressure <60 mm Hg). NIV was necessary in 47 patients (1.5%) and eIT in 1 patient (0.03%). Procedure duration, high body mass index (BMI), high CHADS₂-VASC₂ score, high age, low glomerular filtration rate, diabetes mellitus, and low baseline oxygen saturation were associated with NIV or eIT. The only independent predictor for NIV/eIT was high BMI (>30.1 ± 9.0 kg/m²). Therefore, patients with a BMI of ≥30 had a 40% higher risk for the need of NIV/eIT during the procedure in our study.

Conclusion: Sedation/anti-pain control including midazolam, propofol, and fentanyl administered by EP staff is safe, with only 1.53% requirement of NIV/eIT. High BMI (>30 kg/m²) emerged as an independent predictor for eIT/NIV.

Keywords: Ablation; Atrial fibrillation; Deep sedation; Periprocedural anesthesia; Propofol.