Safety Aspects of Deep Sedation during Catheter Ablation of Atrial Fibrillation

• Published in: Pacing and clinical electrophysiology Vol. 35; no. 1; pp. 38 - 43
• Main Authors: WUTZLER, ALEXANDER, ROLF, SASCHA, HUEMER, MARTIN, PARWANI, ABDUL SHOKOR, BOLDT, LEIF-HENDRIK, HERBERGER, ERIK, HOHENBICHLER, KATHARINA, DIETZ, RAINER, HAVERKAMP, WILHELM
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-01-2012; Wiley
• Subjects: ablation; atrial fibrillation; Atrial Fibrillation - epidemiology; Atrial Fibrillation - surgery; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Catheter Ablation - statistics & numerical data; Deep Sedation - statistics & numerical data; Drug Combinations; Female; Germany - epidemiology; Heart; Humans; Hypnotics and Sedatives; Male; Medical sciences; Midazolam; Middle Aged; Propofol; Risk Assessment; Risk Factors; Treatment Outcome; Germany; Arrhythmia; Heart disease; Atrial fibrillation; Catheter; Cardiovascular disease; Ablation; Excitability disorder
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2011.03260.x

Background:
 The combination of intravenous propofol and midazolam is frequently used to provide unconscious sedation during catheter ablation of atrial fibrillation (AF), but only a very few reports are available on the influence of prolonged propofol infusion on arterial blood gas, blood pressure, and anesthesia‐associated complications during ablation of AF. The purpose of this study was to assess tolerance and safety of unconscious sedation with intravenous propofol and midazolam during catheter ablation of AF.
Methods:
 A total of 316 consecutive patients (age 59 ± 10 years, 68% men) presenting to our center for catheter ablation of symptomatic AF were enrolled prospectively. A total number of 424 procedures were performed under unconscious sedation with propofol and midazolam. SaO2, electrocardiogram, arterial blood pressure, and arterial blood gases were monitored throughout the procedure.
Results:
 Mean procedure duration was 235 ± 48 minutes. Patients received 1.125 ± 684 mg propofol, 9.5 ± 3 midazolam, and 1.963 ± 813 mL NaCl infusion. Complications during the procedure were identified in eight patients (2.5%, one × coronary air embolization, one × myocardial infarction, four × pericardial effusion, two × pericardial tamponade). All eight patients were symptomatic (distress, report of pain); none of the complications was attributable to unconscious sedation itself.
Conclusion:
 Unconscious sedation with propofol and midazolam in AF ablation procedures lasting 3–5 hours did not result in severe changes of vital parameters or serum electrolytes. Anesthesia‐associated problems were not observed. Propofol and midazolam can be safely used during catheter ablation of AF. (PACE 2012; 35:38–43)