Clinical benefits of deep sedation with a supraglottic airway while monitoring the bispectral index during catheter ablation of atrial fibrillation

• Published in: Journal of arrhythmia Vol. 33; no. 4; pp. 283 - 288
• Main Authors: Hida, Satoru, M.D, Takemoto, Masao, M.D., Ph.D, Masumoto, Akihiro, M.D., Ph.D, Mito, Takahiro, M.D., Ph.D, Nagaoka, Kazuhiro, M.D., Ph.D, Kumeda, Hiroshi, M.D, Kawano, Yuki, M.D, Aoki, Ryota, M.D, Kang, Honsa, M.D, Tanaka, Atsushi, M.D., Ph.D, Matsuo, Atsutoshi, M.D, Hironaga, Kiyoshi, M.D., Ph.D, Okazaki, Teiji, M.D., Ph.D, Yoshitake, Kiyonobu, M.D, Tayama, Kei-ichiro, M.D., Ph.D, Kosuga, Ken-ichi, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01-08-2017; Elsevier; Wiley
• Subjects: Ablation; Anesthesia; Atrial fibrillation; bispectral; Bispectral index; Blood pressure; BMI; body mass index; Cardiac arrhythmia; Cardiovascular; Catheter ablation; Catheters; Deep sedation; Esophagus; Hypotension; left atrium; Original; Oxygen saturation; Patients; pulmonary vein antrum isolation; PVAI; radiofrequency catheter ablation; RFCA; SGA; supraglottic airway; Supraglottic airways; Tomography; Veins & arteries; United Kingdom > UK; United States > US; Japan; Bispectral index; AF; body mass index; Catheter ablation; radiofrequency catheter ablation; Supraglottic airways; PVAI; Deep sedation; SGA; BIS; atrial fibrillation; RFCA; LA; pulmonary vein antrum isolation; bispectral; left atrium; supraglottic airway; BMI; BMI, body mass index; RFCA, radiofrequency catheter ablation; SGA, supraglottic airway; Atrial fibrillation; LA, left atrium; AF, atrial fibrillation; BIS, bispectral; PVAI, pulmonary vein antrum isolation
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1016/j.joa.2017.04.001

Abstract Background Pulmonary vein antrum isolation (PVAI) under sedation has proven to be a useful strategy for catheter ablation of atrial fibrillation (AF). Methods To evaluate the clinical benefits of respiratory management using supraglottic airways (SGAs) under deep sedation while monitoring the bispectral (BIS) index during the PVAI and the durations from admission to the catheterization room to starting the radiofrequency energy delivery (Time α ), and from starting the radiofrequency energy delivery to completion of the PVAI (Time β ), X-ray time, frequency of dislocations of the three-dimensional maps (D3DM), procedure-related complications, and proportion of an AF-free rate 15 months after the PVAI (PAFFR) in patients who received deep sedation without SGAs (Group A: n =48) and those with SGAs (Group B: n =51) were evaluated. Results There were no significant differences in patient characteristics, Time α (77±3 versus 78±2 min; p =0.816), complications of cardiac tamponade (2% versus 2%; p =0.966), or PAFFR (81% versus 88%; p =0.313) between the two groups. However, the Time β (84±4 versus 67±3; p =0.001), X-ray time (53±2 versus 34±2; p <0.001), and minor complications of nasal bleeding (25% versus 0%; p =0.001) were significantly shorter and lower in Group B than in Group A, in accordance with a reduction in the hypoxia (15% versus 0%; p =0.007) and D3DM (31% versus 8%; p =0.003). Conclusions These results may demonstrate the clinical benefits of deep sedation with SGAs while monitoring the BIS index without any hypoxia during PVAI in patients with AF.