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Pang N, Pan F, Chen R, Zhang B, Yang Z, Guo M, Wang R. Laryngeal mask airway versus endotracheal intubation as general anesthesia airway managements for atrial fibrillation catheter ablation: a comparative analysis based on propensity score matching. J Interv Card Electrophysiol 2024; 67:1377-1390. [PMID: 38225533 DOI: 10.1007/s10840-024-01742-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/07/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND The current evidence on the use of laryngeal mask airway (LMA) as an airway management technique for general anesthesia (GA) during atrial fibrillation (AF) catheter ablation (CA) is insufficient. This study aims to compare the feasibility, safety, and clinical benefits of LMA and endotracheal intubation (ETI) for airway management in AF CA. METHODS One hundred fifty-two consecutive patients with AF who underwent CA under GA were included and divided into two groups based on different airway management methods (66 in the LMA group, 86 in the ETI group). After propensity score matching, a final analysis cohort of 132 patients was obtained to compare procedural parameters, adverse events, and prognosis between the two groups. RESULTS The LMA group exhibited significantly shorter total procedural time (p = 0.039), anesthesia induction time (p = 0.015), and recovery time (p = 0.006) compared to the ETI group. The mean arterial pressure (MAP) and heart rate were significantly lower in the LMA group during extubation and 1-min post-extubation (p < 0.05). Furthermore, the LMA group demonstrated lower MAP levels during intubation (p = 0.029). The incidences of intraoperative hypotension (p = 0.017) and bradycardia (p = 0.032) were significantly lower in the LMA group. The incidences of delayed recovery or delirium (p = 0.027), laryngeal or airway injury (p = 0.016), cough or bucking (p = 0.001), and sore throat (p < 0.001) were significantly lower in the LMA group. There were no statistically significant differences in catheter stability parameters and sinus rhythm maintenance rates between the two groups (p > 0.05). CONCLUSION LMA is feasible, safe, and effective in AF CA as an optimized airway management technique for GA.
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Affiliation(s)
- Naidong Pang
- Shanxi Medical University, Taiyuan, Shanxi, China
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Feifei Pan
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ruizhe Chen
- Shanxi Medical University, Taiyuan, Shanxi, China
| | | | - Zhen Yang
- Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
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Zylla MM, Imberti JF, Leyva F, Casado-Arroyo R, Braunschweig F, Pürerfellner H, Merino JL, Boriani G. Same-day discharge vs. overnight stay following catheter ablation for atrial fibrillation: a comprehensive review and meta-analysis by the European Heart Rhythm Association Health Economics Committee. Europace 2024; 26:euae200. [PMID: 39077807 PMCID: PMC11321359 DOI: 10.1093/europace/euae200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/25/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) may address the growing socio-economic health burden of the increasing demand for interventional AF therapies. This systematic review and meta-analysis analyses the current evidence on clinical outcomes in SDD after AF ablation compared with overnight stay (ONS). METHODS AND RESULTS A systematic search of the PubMed database was performed. Pre-defined endpoints were complications at short-term (24-96 h) and 30-day post-discharge, re-hospitalization, and/or emergency room (ER) visits at 30-day post-discharge, and 30-day mortality. Twenty-four studies (154 716 patients) were included. Random-effects models were applied for meta-analyses of pooled endpoint prevalence in the SDD cohort and for comparison between SDD and ONS cohorts. Pooled estimates for complications after SDD were low both for short-term [2%; 95% confidence interval (CI): 1-5%; I2: 89%) and 30-day follow-up (2%; 95% CI: 1-4%; I2: 91%). There was no significant difference in complications rates between SDD and ONS [short-term: risk ratio (RR): 1.62; 95% CI: 0.52-5.01; I2: 37%; 30 days: RR: 0.65; 95% CI: 0.42-1.00; I2: 95%). Pooled rates of re-hospitalization/ER visits after SDD were 4% (95% CI: 1-10%; I2: 96%) with no statistically significant difference between SDD and ONS (RR: 0.86; 95% CI: 0.58-1.27; I2: 61%). Pooled 30-day mortality was low after SDD (0%; 95% CI: 0-1%; I2: 33%). All studies were subject to a relevant risk of bias, mainly due to study design. CONCLUSION In this meta-analysis including a large contemporary cohort, SDD after AF ablation was associated with low prevalence of post-discharge complications, re-hospitalizations/ER visits and mortality, and a similar risk compared with ONS. Due to limited quality of current evidence, further prospective, randomized trials are needed to confirm safety of SDD and define patient- and procedure-related prerequisites for successful and safe SDD strategies.
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Affiliation(s)
- Maura M Zylla
- Department of Cardiology, Heidelberg Center of Heart Rhythm Disorders, Medical University Hospital, Im Neuenheimer Feld 410, Heidelberg, Germany
- Health Economics Committee of EHRA (European Heart Rhythm Association)
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francisco Leyva
- Health Economics Committee of EHRA (European Heart Rhythm Association)
- Aston Medical Research Institute, Aston Medical School, Aston University, Aston Triangle, B4 7ET Birmingham, UK
| | - Ruben Casado-Arroyo
- Health Economics Committee of EHRA (European Heart Rhythm Association)
- Department of Cardiology, H.U.B. Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Frieder Braunschweig
- Health Economics Committee of EHRA (European Heart Rhythm Association)
- Department of Medicine, Solna, Karolinska Institutet
- ME Cardiology, Karolinska University Hospital, Norrbacka S1:02, Eugeniavagen 27, 171 77 Stockholm, Sweden
| | - Helmut Pürerfellner
- Department of Cardiology, Public Hospital Elisabethinen, Academic Teaching Hospital, Ordensklinikum A-4020 Linz, Fadingerstraße 1, Austria
| | - José L Merino
- Arrhythmia-Robotic Electrophysiology Unit, La Paz University Hospital, IdiPAZ, Universidad Autonoma, Madrid, Spain
| | - Giuseppe Boriani
- Health Economics Committee of EHRA (European Heart Rhythm Association)
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121 Modena, Italy
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Kistler PM, Sanders P, Amarena JV, Bain CR, Chia KM, Choo WK, Eslick AT, Hall T, Hopper IK, Kotschet E, Lim HS, Ling LH, Mahajan R, Marasco SF, McGuire MA, McLellan AJ, Pathak RK, Phillips KP, Prabhu S, Stiles MK, Sy RW, Thomas SP, Toy T, Watts TW, Weerasooriya R, Wilsmore BR, Wilson L, Kalman JM. 2023 Cardiac Society of Australia and New Zealand Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation. Heart Lung Circ 2024; 33:828-881. [PMID: 38702234 DOI: 10.1016/j.hlc.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 05/06/2024]
Abstract
Catheter ablation for atrial fibrillation (AF) has increased exponentially in many developed countries, including Australia and New Zealand. This Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation from the Cardiac Society of Australia and New Zealand (CSANZ) recognises healthcare factors, expertise and expenditure relevant to the Australian and New Zealand healthcare environments including considerations of potential implications for First Nations Peoples. The statement is cognisant of international advice but tailored to local conditions and populations, and is intended to be used by electrophysiologists, cardiologists and general physicians across all disciplines caring for patients with AF. They are also intended to provide guidance to healthcare facilities seeking to establish or maintain catheter ablation for AF.
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Affiliation(s)
- Peter M Kistler
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia.
| | - Prash Sanders
- University of Adelaide, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Chris R Bain
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Karin M Chia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Wai-Kah Choo
- Gold Coast University Hospital, Gold Coast, Qld, Australia; Royal Darwin Hospital, Darwin, NT, Australia
| | - Adam T Eslick
- University of Sydney, Sydney, NSW, Australia; The Canberra Hospital, Canberra, ACT, Australia
| | | | - Ingrid K Hopper
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Emily Kotschet
- Victorian Heart Hospital, Monash Health, Melbourne, Vic, Australia
| | - Han S Lim
- University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia; Northern Health, Melbourne, Vic, Australia
| | - Liang-Han Ling
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Rajiv Mahajan
- University of Adelaide, Adelaide, SA, Australia; Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Silvana F Marasco
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | | | - Alex J McLellan
- University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia; St Vincent's Hospital, Melbourne, Vic, Australia
| | - Rajeev K Pathak
- Australian National University and Canberra Heart Rhythm, Canberra, ACT, Australia
| | - Karen P Phillips
- Brisbane AF Clinic, Greenslopes Private Hospital, Brisbane, Qld, Australia
| | - Sandeep Prabhu
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Martin K Stiles
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Raymond W Sy
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Stuart P Thomas
- University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia
| | - Tracey Toy
- The Alfred Hospital, Melbourne, Vic, Australia
| | - Troy W Watts
- Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Rukshen Weerasooriya
- Hollywood Private Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia
| | | | | | - Jonathan M Kalman
- University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia
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Wahedi R, Willems S, Feldhege J, Jularic M, Hartmann J, Anwar O, Dickow J, Harloff T, Gessler N, Gunawardene MA. Pulsed-field versus cryoballoon ablation for atrial fibrillation-Impact of energy source on sedation and analgesia requirement. J Cardiovasc Electrophysiol 2024; 35:162-170. [PMID: 38009545 DOI: 10.1111/jce.16141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Pulsed field ablation (PFA) represents a novel, nonthermal energy modality that can be applied for single-shot pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative data with regard to deep sedation to established single-shot modalities such as cryoballoon (CB) ablation are scarce. The aim of this study was to compare a deep sedation protocol in patients receiving PVI with either PFA or CB. METHODS Prospective, consecutive AF patients undergoing PVI with a pentaspline PFA catheter were compared to a retrospective CB-PVI cohort of the same timeframe. Study endpoints were the requirements of analgesics, cardiorespiratory stability, and sedation-associated complications. RESULTS A total of 100 PVI patients were included (PFA n = 50, CB n = 50, mean age 66 ± 10.6, 61% male patients, 65% paroxysmal AF). Requirement of propofol, midazolam, and sufentanyl was significantly higher in the PFA group compared to CB [propofol 0.14 ± 0.04 mg/kg/min in PFA vs. 0.11 ± 0.04 mg/kg/min in CB (p = .001); midazolam 0.00086 ± 0.0004 mg/kg/min in PFA vs. 0.0006295 ± 0.0003 mg/kg/min in CB (p = .002) and sufentanyl 0.0013 ± 0.0007 µg/kg/min in PFA vs. 0.0008 ± 0.0004 µg/kg/min in CB (p < .0001)]. Sedation-associated complications did not differ between both groups (PFA n = 1/50 mild aspiration pneumonia, CB n = 0/50, p > .99). Nonsedation-associated complications (PFA: n = 2/50, 4%, CB: n = 1/50, 2%, p > .99) and procedure times (PFA 75 ± 31, CB 84 ± 32 min, p = .18) did not differ between groups. CONCLUSIONS PFA is associated with higher sedation and especially analgesia requirements. However, the safety of deep sedation does not differ to CB ablation.
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Affiliation(s)
- Rahin Wahedi
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | | | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Jannis Dickow
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Tim Harloff
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Nele Gessler
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
- Asklepios Proresearch, Hamburg, Germany
| | - Melanie A Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
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5
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Bock M, O’Connor M, Chouchane A, Schmidt P, Schaarschmidt C, Knoll K, Bahlke F, Englert F, Storz T, Kottmaier M, Trenkwalder T, Reents T, Bourier F, Telishevska M, Lengauer S, Hessling G, Deisenhofer I, Kolb C, Lennerz C. Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis. J Clin Med 2023; 12:4900. [PMID: 37568301 PMCID: PMC10420171 DOI: 10.3390/jcm12154900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The demand for transvenous lead extraction (TLE) has increased. In line with this, the safety of such procedures has also increased. Traditionally, TLE is performed under resource-intensive general anaesthesia. This study aims to evaluate the safety and outcomes of Cardiologist-lead deep sedation for TLE. METHODS We retrospectively analysed 328 TLE procedures performed under deep sedation from 2016 to 2019. TLE procedures were performed by experienced electrophysiologists. Sedation was administered by a specifically trained cardiologist (bolus midazolam/fentanyl and propofol infusion). Procedural sedation data including blood pressure, medication administration and sedation time were collected. Complications related to sedation and the operative component of the procedure were analysed retrospectively. RESULTS The sedation-associated complication rate during TLE was 22.0%. The most common complication (75% of complications) was hypotension requiring noradrenaline, followed by bradycardia requiring atropine (13% of complications). Additionally, the unplanned presence of an anaesthesiologist was needed in one case (0.3%). Deep sedation was achieved with midazolam (mean dose 42.9 ± 26.5 µg/kg), fentanyl (mean dose 0.4 ± 0.6 µg/kg) and propofol (mean dose 3.5 ± 1.2 mg/kg/h). There was no difference in medication dosage between those with a sedation-associated complication and those without. Sedation-associated complications appeared significantly more in patients with reduced LVEF (p = 0.01), renal impairment (p = 0.01) and a higher American Society of Anaesthesiologists (ASA) class (p = 0.01). CONCLUSION Deep sedation for TLE can be safely performed by a specifically trained cardiologist, with a transition to general anaesthesia required in only 0.3% of cases. We continue to recommend the on-call availability of an anaesthesiologist and cardiac surgeon in case of major complications.
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Affiliation(s)
- Matthias Bock
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
| | - Matthew O’Connor
- Auckland City Hospital, Department of Cardiology, Auckland 1023, New Zealand
| | - Amir Chouchane
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Philip Schmidt
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Claudia Schaarschmidt
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Katharina Knoll
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
| | - Fabian Bahlke
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Florian Englert
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Theresa Storz
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Marc Kottmaier
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Teresa Trenkwalder
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Tilko Reents
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Felix Bourier
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Marta Telishevska
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Sarah Lengauer
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Gabriele Hessling
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Isabel Deisenhofer
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Christof Kolb
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Carsten Lennerz
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
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Bogossian H, Robl S, Bimpong-Buta NY, Iliodromitis K. [Initiation and maintenance of atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2023; 34:169-172. [PMID: 37140825 DOI: 10.1007/s00399-023-00939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Harilaos Bogossian
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstraße 20, 58135, Hagen, Deutschland.
- Universität Witten/Herdecke, Witten, Deutschland.
| | - Sebastian Robl
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstraße 20, 58135, Hagen, Deutschland
| | - Nana-Yaw Bimpong-Buta
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstraße 20, 58135, Hagen, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - Konstantinos Iliodromitis
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstraße 20, 58135, Hagen, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
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7
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Mahmoodi E, Leitch J, Davies A, Leigh L, Oldmeadow C, Dwivedi J, Boyle A, Jackson N. The importance of anaesthesia in atrial fibrillation ablation: Comparing conscious sedation with general anaesthesia. Indian Pacing Electrophysiol J 2023; 23:47-52. [PMID: 36509310 PMCID: PMC10014632 DOI: 10.1016/j.ipej.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/18/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND General anaesthesia (GA) for atrial fibrillation (AF) ablation is often preferred over conscious sedation (CS) to minimize patient discomfort and reduce the risk of map disruption from patient movement but may pose an additional risk to some patients with significant comorbidity or poor cardiac function. METHODS We extracted data for 300 patients who underwent AF ablation between the years 2017 and 2019 and compared the outcomes of AF ablation with CS and GA. RESULTS Compared to the GA group, patients were younger in the CS group (63 versus 66 years, p = 0.02), had less persistent AF (34% versus 46%, p = 0.048) and the left atrial dimension was smaller (41 versus 45 mm, p = 0.01). More patients had cryoballoon ablation (CBA) than radiofrequency (RFA) ablation in the CS than the GA group (88% CB with CS and 56% RF with GA, p < 0.01), frequency of ASA score 3-4 (higher anaesthetic risk) was less for CS than for GA (45% versus 75%, p < 0.01), and procedural duration was shorter for patients who had CS (110 versus 139 min, p < 0.001). Of the patients receiving CS, 127/182 (70%) were planned for same day discharge (SDD) and this occurred in 120 (94%) of those patients. There were no significant differences in complication rates between the groups (5.1% in GA and 6% in CS, p = 0.8). AF type was the only significant predictor of freedom from AF recurrence on multivariate analysis (HR 0.33, 0.13-0.82, p = 0.018). CONCLUSION In this study, the use of CS compared with GA for AF ablation was associated with similar outcomes and complication rates.
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Affiliation(s)
| | - Jim Leitch
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; The University of Newcastle, Newcastle, NSW, Australia
| | - Allan Davies
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Lucy Leigh
- The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Christopher Oldmeadow
- The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jovita Dwivedi
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Andrew Boyle
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Nicholas Jackson
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; The University of Newcastle, Newcastle, NSW, Australia
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8
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Sedation and anaesthetic strategies during cardiac electrophysiology studies and ablation. Eur J Anaesthesiol 2022; 39:956-960. [DOI: 10.1097/eja.0000000000001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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9
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Empfehlungen zur Sondenextraktion – Gemeinsame Empfehlungen der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG). ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Homberg MC, Bouman EA, Linz D, van Kuijk SMJ, Joosten BA, Buhre WF. High-flow nasal cannula versus standard low-flow nasal cannula during deep sedation in patients undergoing radiofrequency atrial fibrillation catheter ablation: a single-centre randomised controlled trial. Trials 2022; 23:378. [PMID: 35534903 PMCID: PMC9082831 DOI: 10.1186/s13063-022-06362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To our knowledge, there are few trials studying the effect of high-flow nasal cannula (HFNC) during deep sedation. Our hypothesis is that high-flow nasal cannula (HFNC) will prevent hypoxemia and desaturation as compared to low-flow nasal cannula (LFNC) during prolonged deep sedation in patients with atrial fibrillation undergoing radiofrequency catheter ablation (RFCA).
Methods
A single-centre, randomised controlled trial with HFNC as the intervention and LFNC as the control group. A total of 94 adult patients per group undergoing elective radiofrequency atrial fibrillation catheter ablation under deep sedation. will be included. The primary outcome is the lowest oxygen saturation (SpO2). Secondary outcomes are as follows: the duration of lowest SpO2, cross over from oxygen therapy in both directions, incidence of SpO2 below 90% > 60 seconds, adverse sedation events, adverse effects of HFNC, mean CO2, peak CO2 and patients experience with oxygen therapy. The study will take place during the 2-day admission period for RFCA. Patients can fill out their questionnaires in the first week after treatment.
Discussion
HFNC is increasingly used as a technique for oxygen delivery in procedural sedation and analgesia. We hypothesise that HFNC is superior to the standard treatment LFNC in patients under deep sedation with respect to the incidence of desaturation. To our knowledge, there are no adequately powered clinical trial studies on the effects of HFNC in prolonged deep sedation.
Trial registration
ClinicalTrials.gov NCT04842253. Registered on 04 April 2021
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11
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Phillips V, Schauvliege S, Decloedt A, Van Steenkiste G, van Loon G. Anaesthetic management for cardiac 3D electro‐anatomical mapping and radiofrequency catheter ablation in a horse with sustained atrial tachycardia. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Victoria Phillips
- Willows Veterinary Centre and Referral Service Highlands Road Shirley UK
- Department of Surgery and Anaesthesia of Domestic Animals Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Stijn Schauvliege
- Department of Surgery and Anaesthesia of Domestic Animals Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Annelies Decloedt
- Equine Cardioteam Department of Large Animal Internal Medicine Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Department of Large Animal Internal Medicine Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Gunther van Loon
- Equine Cardioteam Department of Large Animal Internal Medicine Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
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12
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Servatius H, Küffer T, Baldinger SH, Asatryan B, Seiler J, Tanner H, Novak J, Lam A, Noti F, Haeberlin A, Madaffari A, Sweda R, Mühl A, Branca M, Dütschler S, Erdoes G, Stüber F, Theiler L, Reichlin T, Roten L. Dexmedetomidine versus Propofol for Operator-Directed Nurse-Administered Procedural Sedation during Catheter Ablation of Atrial Fibrillation: a Randomized Controlled Study. Heart Rhythm 2021; 19:691-700. [PMID: 34971816 DOI: 10.1016/j.hrthm.2021.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Operator-directed nurse-administered (ODNA) sedation with propofol is the preferred sedation technique for catheter ablation of atrial fibrillation (AF) in many centers. OBJECTIVE We aimed to investigate whether Dexmedetomidine, an α2-adrenergic receptor agonist, is superior to propofol. METHODS We randomized 160 consecutive patients undergoing first AF ablation to ODNA sedation by dexmedetomidine (DEX group) versus propofol (PRO group), according to a standardized protocol. Patients were unaware of treatment allocation. The primary endpoint was a composite of inefficient sedation, termination/change of sedation protocol or procedure abortion, hypercapnia (transcutaneous CO2 >55 mmHg), hypoxemia (SpO2 <90%) or intubation, prolonged hypotension (systolic blood pressure <80 mmHg), and sustained bradycardia necessitating cardiac pacing. Secondary endpoints were the components of the primary endpoint and patient satisfaction with procedural sedation, as assessed by a standardized questionnaire the day following ablation. RESULTS The primary endpoint occurred in 15 DEX group and 25 PRO group patients (19% vs. 31%; p=0.068). Hypercapnia was significantly more frequent in PRO group patients (29% vs. 10%; p=0.003). There was no significant difference among the other components of the primary endpoint, no procedure was aborted. Patient satisfaction was significantly better in PRO group patients (visual analog scale 0-100; median 100 in PRO group vs. median 93 in DEX group; p<0.001). CONCLUSION Efficacy of ODNA sedation with dexmedetomidine was not different to propofol. Hypercapnia occurs less frequent with dexmedetomidine, but patient satisfaction is better with propofol sedation. In selected patients, dexmedetomidine may be used as an alternative to propofol for ODNA sedation during AF ablation. (ClinicalTrials.gov number NCT03844841).
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Affiliation(s)
- Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Novak
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Romy Sweda
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Sophie Dütschler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Frank Stüber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lorenz Theiler
- Department of Anaesthesiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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13
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Palmisano P, Ziacchi M, Angeletti A, Guerra F, Forleo GB, Bertini M, Notarstefano P, Accogli M, Lavalle C, Bisignani G, Landolina M, Zanotto G, D’Onofrio A, Ricci RP, De Ponti R, Boriani G. The Practice of Deep Sedation in Electrophysiology and Cardiac Pacing Laboratories: Results of an Italian Survey Promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing). J Clin Med 2021; 10:jcm10215035. [PMID: 34768557 PMCID: PMC8584354 DOI: 10.3390/jcm10215035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 01/23/2023] Open
Abstract
The aim of this survey, which was open to all Italian cardiologists involved in arrhythmia, was to assess common practice regarding sedation and analgesia in interventional electrophysiology procedures in Italy. The survey consisted of 28 questions regarding the approach to sedation used for elective direct-current cardioversion (DCC), subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation, atrial fibrillation (AF) ablation, ventricular tachycardia (VT) ablation, and transvenous lead extraction procedures. A total of 105 cardiologists from 92 Italian centres took part in the survey. The rate of centres where DCC, S-ICD implantation, AF ablation, VT ablation and lead extraction procedures were performed without anaesthesiologic assistance was 60.9%, 23.6%, 51.2%, 37.3%, and 66.7%, respectively. When these procedures were performed without anaesthesiologic assistance, the drugs (in addition to local anaesthetics) commonly administered were benzodiazepines (from 64.3% to 79.6%), opioids (from 74.4% to 88.1%), and general anaesthetics (from 7.1% to 30.4%). Twenty-three (21.9%) of the 105 cardiologists declared that they routinely administered propofol, without the supervision of an anaesthesiologist, in at least one of the above-mentioned procedures. In current Italian clinical practice, there is a lack of uniformity in the sedation/analgesia approach used in interventional electrophysiology procedures.
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Affiliation(s)
- Pietro Palmisano
- Cardiology Unit, “Card. G. Panico” Hospital, 73039 Tricase, Italy;
- Correspondence:
| | - Matteo Ziacchi
- Institute of Cardiology, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.Z.); (A.A.)
| | - Andrea Angeletti
- Institute of Cardiology, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.Z.); (A.A.)
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, 60126 Ancona, Italy;
| | | | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria Di Ferrara “Arcispedale S. Anna”, 44124 Cona, Ferrara, Italy;
| | | | - Michele Accogli
- Cardiology Unit, “Card. G. Panico” Hospital, 73039 Tricase, Italy;
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, 00161 Roma, Italy;
| | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, 87012 Castrovillari, Italy;
| | | | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, 37045 Legnago, Verona, Italy;
| | - Antonio D’Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, 80131 Naples, Italy;
| | | | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale Di Circolo-University of Insubria, 21100 Varese, Italy;
| | - Giuseppe Boriani
- Department of Biomedical, Metabolic and Neural Sciences, Cardiology Division, University of Modena and Reggio Emilia, Policlinico Di Modena, 41121 Modena, Italy;
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14
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Tilz RR, Lenz C, Sommer P, Roza MS, Sarver AE, Williams CG, Heeger C, Hindricks G, Vogler J, Eitel C. Focal Impulse and Rotor Modulation Ablation vs. Pulmonary Vein isolation for the treatment of paroxysmal Atrial Fibrillation: results from the FIRMAP AF study. Europace 2021; 23:722-730. [PMID: 33351076 PMCID: PMC8139814 DOI: 10.1093/europace/euaa378] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS Pulmonary vein isolation (PVI) is the gold standard for atrial fibrillation (AF) ablation. Recently, catheter ablation targeting rotors or focal sources has been developed for treatment of AF. This study sought to compare the safety and effectiveness of Focal Impulse and Rotor Modulation (FIRM)-guided ablation as the sole ablative strategy with PVI in patients with paroxysmal AF. METHODS AND RESULTS We conducted a multicentre, randomized trial to determine whether FIRM-guided radiofrequency ablation without PVI (FIRM group) was non-inferior to PVI (PVI group) for treatment of paroxysmal AF. The two primary efficacy end points were (i) acute success defined as elimination of AF rotors (FIRM group) or isolation of all pulmonary veins (PVI group) and (ii) long-term success defined as single-procedure freedom from AF/atrial tachycardia (AT) recurrence 12 months after ablation. The study was closed early by the sponsor. At the time of study closure, any pending follow-up visits were waived. A total of 51 patients (mean age 63 ± 10.6 years, 57% male) were enrolled. All PVs were successfully isolated in the PVI group and all rotors were successfully eliminated in the FIRM group. Single-procedure effectiveness was 31.3% (5/16) in the FIRM group and 80% (8/10) in the PVI group at 12 months. Three vascular access complications occurred in the FIRM group. CONCLUSION These partial study effectiveness results reinforce the importance of PVI in paroxysmal AF patients and indicate that FIRM-guided ablation alone (without PVI) is not an effective strategy for treatment of paroxysmal AF in most patients.
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Affiliation(s)
- Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II, Department of Electrophysiology, Lübeck, Germany
| | - Corinna Lenz
- Unfallkrankenhaus Berlin, Klinik für Innere Medizin/Kardiologie, Berlin, Germany
| | - Philipp Sommer
- Heart Center Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - Meyer-Saraei Roza
- University Heart Center Lübeck, Medical Clinic II, Department of Electrophysiology, Lübeck, Germany
| | | | | | - Christian Heeger
- University Heart Center Lübeck, Medical Clinic II, Department of Electrophysiology, Lübeck, Germany
| | - Gerhard Hindricks
- Heart Center Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - Julia Vogler
- University Heart Center Lübeck, Medical Clinic II, Department of Electrophysiology, Lübeck, Germany
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II, Department of Electrophysiology, Lübeck, Germany
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15
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Zedda A, Huo Y, Kronborg M, Ulbrich S, Mayer J, Pu L, Richter U, Gaspar T, Piorkowski J, Piorkowski C. Left Atrial Isolation and Appendage Occlusion in Patients With Atrial Fibrillation at End-Stage Left Atrial Fibrotic Disease. Circ Arrhythm Electrophysiol 2021; 14:e010011. [PMID: 34270906 DOI: 10.1161/circep.121.010011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Angela Zedda
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Yan Huo
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Mads Kronborg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (M.K.)
| | - Stefan Ulbrich
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Julia Mayer
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Liying Pu
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Utz Richter
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Thomas Gaspar
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | | | - Christopher Piorkowski
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
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16
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Chang TY, Lo LW, Te ALD, Ishigaki S, Maesato A, Lin YJ, Chang SL, Hu YF, Chung FP, Lin CY, Chao TF, Liao JN, Tuan TC, Kuo L, Wu CI, Liu CM, Jain A, Lugtu IC, Higa S, Chen SA. Deep Sedation with Intravenous Anesthesia Is Associated with Outcome in Patients Undergoing Cryoablation for Paroxysmal Atrial Fibrillation. Int Heart J 2021; 62:779-785. [PMID: 34234078 DOI: 10.1536/ihj.20-819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Whether deep sedation with intravenous anesthesia will affect the recurrence after cryoballoon ablation (CBA) of paroxysmal atrial fibrillation (AF) is yet to be examined. Thus, in this study, we hypothesize that there is difference in terms of the recurrence between local anesthesia and deep sedation with intravenous anesthesia after an index ablation procedure.In total, 109 patients were enrolled and received CBA, of which 68 (58.2 years) patients underwent pulmonary vein (PV) isolation with a local anesthesia (group 1) and 41 patients (63.2 years) underwent PV isolation with deep sedation using intravenous anesthesia (group 2).During the index procedure, isolation of all major PVs was achieved in 66 patients in group 1 and in 41 patients in group 2. There was no difference in non-PV triggers between the two groups. The periprocedural complication was found to be similar between the two groups (2.9% in group 1 and 4.9% in group 2). Further, 17 patients in group 1 and 4 patients in group 2 experienced recurrences after a follow-up of 19.3 months (P = 0.019). Repeat procedures revealed similar PV reconnection rates between the two groups. It has also been noted that the number of reconnected PV and incidence of atypical flutter seem to increase in group 1.Deep sedation with intravenous anesthesia during CBA for paroxysmal AF is safe and had a better long-term outcome than those with local anesthesia.
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Affiliation(s)
- Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | | | - Sugako Ishigaki
- Division of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Laboratory, Makiminato Central Hospital
| | - Akira Maesato
- Division of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Laboratory, Makiminato Central Hospital
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Tze-Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Jo-Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Ta-Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Cheng-I Wu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University
| | - Ankit Jain
- Vardhman Mahavir Medical College and Safdarjung Hospital
| | | | - Satoshi Higa
- Division of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Laboratory, Makiminato Central Hospital
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Division of Cardiology, Taipei Veterans General Hospital.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang Ming Chiou Tung University.,Cardiovascular Center, Taichung Veterans General Hospital
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17
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Kawaguchi N, Suzuki A, Usui M, Yoshikawa S, Watanabe S, Maeno R, Kujiraoka H, Sato K, Goya M, Sasano T. Clinical Effect of Adaptive Servo-Ventilation on Left Atrial Pressure During Catheter Ablation in Sedated Patients With Atrial Fibrillation. Circ J 2021; 85:1321-1328. [PMID: 33854003 DOI: 10.1253/circj.cj-20-1263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sedation during pulmonary vein isolation (PVI) for atrial fibrillation often provokes a decline in left atrial (LA) pressure (LAP) under atmospheric pressure and increases the risk of systemic air embolisms. This study aimed to investigate the efficacy of adaptive servo-ventilation (ASV) on the LAP in sedated patients.Methods and Results:Fifty-one consecutive patients undergoing cryoballoon PVI were enrolled. All patients underwent sedation using propofol throughout the procedure. After the transseptal puncture and the insertion of a long sheath into the LA, the LAP was measured. Then, the ASV treatment was started, and the LAP was re-measured. The LAP before and after the ASV support was investigated. Before ASV, the LAP during the inspiratory phase was significantly smaller than that during the expiratory phase (4.9±5.4 mmHg vs. 14.0±5.2 mmHg, P<0.01). The lowest LAP was -2.2±5.1 mmHg and was under 0 mmHg in 37 (73%) patients. After the ASV, the LAP during the inspiratory phase significantly increased to 8.9±4.1 mmHg (P<0.01), and lowest LAP increased to 4.7±5.9 mmHg (P<0.01). The negative lowest LAP value became positive in 30/37 (81%) patients. There were no statistical differences regarding obstructive sleep apnea (OSA), obesity, gender, or other comorbidities between patients with and without a negative lowest LAP after ASV support. CONCLUSIONS ASV is effective for increasing the LAP above 0 mmHg and might prevent air embolisms during PVI.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Masahiko Goya
- Department of Cardiology, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University
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18
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Ahn JH, Park J, Jo JS, Lee SH, On YK, Park KM, Oh EJ, Ko JS, Jeong JS. The frequency of gastroesophageal reflux when radiofrequency catheter ablation procedures for atrial fibrillation under general anesthesia with a supraglottic device: Observational pilot study. Medicine (Baltimore) 2021; 100:e24595. [PMID: 33578560 PMCID: PMC7886399 DOI: 10.1097/md.0000000000024595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
Gastroesophageal reflux (GER) in radiofrequency catheter ablation (RFCA) occurs due to vagal plexus damage during pulmonary vein isolation. We hypothesized that the frequency of GER in the oropharynx will be less compared to other areas (low-esophagus, mid-esophagus). We confirmed the frequency of GER before and after RFCA in 3 areas.We studied 30 patients who were scheduled for RFCA under general anesthesia. Anesthesia was performed using supraglottic devices (SGD) with a suction port. Two esophageal temperature probes capable of suction and measuring temperature were inserted through the suction port. The pH of the 3 areas was measured before and after the RFCA at 3 areas (mid-esophagus, low-esophagus, and oropharynx).GER was observed in 13 of 30 patients (43%). In one patient, it was observed in the oropharynx, in 4 patients it was observed in the mid-esophagus, and in 13 patients, it was observed in the low-esophagus. For patients with GER at the oropharynx and mid-esophagus, it was also observed at the low-esophagus. The difference in the pH before and after the RFCA was not significant at the oropharynx and mid-esophagus (P = .726 and P = .424, respectively), but it was significantly different at the low-esophagus (P < .001). The total ablation time was longer in the GER group compared to the non-GER group (P = .021).GER after RFCA occurred in 43% of patients, only 1 patient in the oropharynx. And aspiration pneumonia after SGD extubation did not occur. Therefore, the use of SGDs in RFCA does not completely eliminate the possibility of aspiration, so care should be taken.
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Affiliation(s)
- Jin Hee Ahn
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul
| | - Jiyeon Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon
| | - Jae Seong Jo
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul
| | - Sung Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul
| | - Young Keun On
- Department of Cardiology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyoung-Min Park
- Department of Cardiology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun Jeong Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine
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Weinmann K, Heudorfer R, Lenz A, Aktolga D, Rattka M, Bothner C, Pott A, Öchsner W, Rottbauer W, Dahme T. Safety of conscious sedation in electroanatomical mapping procedures and cryoballoon pulmonary vein isolation. Heart Vessels 2020; 36:561-567. [PMID: 33211151 PMCID: PMC7940268 DOI: 10.1007/s00380-020-01725-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
Immobilization of patients during electrophysiological procedures, to avoid complications by patients' unexpected bodily motion, is achieved by moderate to deep conscious sedation using benzodiazepines and propofol for sedation and opioids for analgesia. Our aim was to compare respiratory and hemodynamic safety endpoints of cryoballoon pulmonary vein isolation (PVI) and electroanatomical mapping (EAM) procedures. Included patients underwent either cryoballoon PVI or EAM procedures. Sedation monitoring included non-invasive blood pressure measurements, transcutaneous oxygen saturation (tSpO2) and transcutaneous carbon-dioxide (tpCO2) measurements. We enrolled 125 consecutive patients, 67 patients underwent cryoballoon atrial fibrillation ablation and 58 patients had an EAM and radiofrequency ablation procedure. Mean procedure duration of EAM procedures was significantly longer (p < 0.001) and propofol doses as well as morphine equivalent doses of administered opioids were significantly higher in EAM patients compared to cryoballoon patients (p < 0.001). Cryoballoon patients display higher tpCO2 levels compared to EAM patients at 30 min (cryoballoon: 51.1 ± 7.0 mmHg vs. EAM: 48.6 ± 6.2 mmHg, p = 0.009) and at 60 min (cryoballoon: 51.4 ± 7.3 mmHg vs. EAM: 48.9 ± 6.6 mmHg, p = 0.07) procedure duration. Mean arterial pressure was significantly higher after 60 min (cryoballoon: 84.7 ± 16.7 mmHg vs. EAM: 76.7 ± 13.3 mmHg, p = 0.017) in cryoballoon PVI compared to EAM procedures. Regarding respiratory and hemodynamic safety endpoints, no significant difference was detected regarding hypercapnia, hypoxia and episodes of hypotension. Despite longer procedure duration and deeper sedation requirement, conscious sedation in EAM procedures appears to be as safe as conscious sedation in cryoballoon ablation procedures regarding hemodynamic and respiratory safety endpoints.
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Affiliation(s)
- Karolina Weinmann
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Regina Heudorfer
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Alexia Lenz
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Deniz Aktolga
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Manuel Rattka
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Carlo Bothner
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Alexander Pott
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Wolfgang Öchsner
- Department of Anesthesiology, Ulm University Medical Center, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Tillman Dahme
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany.
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Cui HM, Wu F, Wang WT, Qian J, Li J, Fan M. Acupuncture Anesthesia for Radiofrequency Catheter Ablation in Treatment of Persistent Atrial Fibrillation: A Case Report. Chin J Integr Med 2020; 27:137-140. [PMID: 33140206 DOI: 10.1007/s11655-020-3436-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Hai-Ming Cui
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Feng Wu
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Wen-Ting Wang
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Jia Qian
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Jing Li
- Department of Acupuncture and Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Min Fan
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
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Continuous transcutaneous carbon-dioxide monitoring to avoid hypercapnia in complex catheter ablations under conscious sedation. Int J Cardiol 2020; 325:69-75. [PMID: 33027681 DOI: 10.1016/j.ijcard.2020.09.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ablation of complex cardiac arrhythmias requires an immobilized patient. For a successful and safe intervention and for patient comfort, this can be achieved by conscious sedation. Administered sedatives and analgesics have respiratory depressant side effects and require close monitoring. We investigated the feasibility and accuracy of additional, continuous transcutaneous carbon-dioxide partial pressure (tpCO2) measurement during conscious sedation in complex electrophysiological catheter ablation procedures. METHOD We evaluated the accuracy and additional value of continuous tpCO2 detection by application of a Severinghaus electrode in comparison to arterial and venous blood gas analyses. RESULTS We included 110 patients in this prospective observational study. Arterial pCO2 (paCO2) and tpCO2 showed good correlation throughout the procedures (r = 0.60-0.87, p < 0.005). Venous pCO2 (pvCO2) were also well correlated to transcutaneous values (r = 0.65-0.85, p < 0.0001). Analyses of the difference of pvCO2 and tpCO2 measurements showed a tolerance within <10 mmHg in up to 96-98% of patients. Hypercapnia (pCO2 < 70 mmHg) was detected more likely and earlier by continuous tpCO2 monitoring compared to half-hourly pvCO2 measurements. CONCLUSION Continuous tpCO2 monitoring is feasible and precise with good correlation to arterial and venous blood gas carbon-dioxide analysis during complex catheter ablations under conscious sedation and may contribute to additional safety.
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Osorio J, Rajendra A, Varley A, Henry R, Cunningham J, Spear W, Morales G. General anesthesia during atrial fibrillation ablation: Standardized protocol and experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:602-608. [PMID: 32333408 DOI: 10.1111/pace.13928] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/01/2020] [Accepted: 04/19/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Most atrial fibrillation (AF) ablations are performed with general anesthesia (GA). The ideal GA protocol is unknown, but it affects ablation outcomes and laboratory utilization. We sought to report a GA protocol used at a high-volume center, with special consideration on efficiency and optimization of mapping and ablation conditions. METHODS Our protocol consists of propofol as sole anesthetic agent and analgesia with Fentanyl. IV fluids are minimized. After transseptal access, the right phrenic nerve is tagged, rocuronium is given, and redosing avoided. Ventilation is modulated to optimize mapping and ablation. After ablation, isoproterenol is infused for 20 min. After 10 min, propofol is gradually decreased and ventilation set to SIMV 8 breaths/min to promote spontaneous breathing, and then switched to pressure support and propofol stopped. Paralysis is reversed and furosemide given. Patient is extubated once meeting standard criteria. RESULTS A total of 1286 patients underwent AF ablation from January 2017 to December 2018 using the protocol. Mean age was 66 years (41% paroxysmal AF, CHADS2Vasc 2.6). Total procedure time was 86 min. Median time to extubation was 9 min (first and third quartile 6-16) after procedure completed, with total anesthesia time of 116 min. On average 370 mL of fluids were given by anesthesia. Only one patient who had heart failure required reintubation with no other anesthesia-related complications seen. CONCLUSION Our GA protocol was specifically designed for AF ablation. It was safe and led to efficient recovery and extubation times. It maximizes laboratory utilization time without compromising safety.
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Affiliation(s)
- Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama
| | - Allyson Varley
- Heart Rhythm Clinical and Research Solution, Birmingham, Alabama
| | - Robert Henry
- Arrhythmia Institute at Grandview, Birmingham, Alabama
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Stauber A, Kornej J, Sepehri Shamloo A, Dinov B, Bacevicius J, Dagres N, Bollmann A, Hindricks G, Sommer P. Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures. Cardiol J 2020; 28:671-677. [PMID: 32207839 DOI: 10.5603/cj.a2020.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/18/2020] [Accepted: 03/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the current study was to analyze the impact of single versus double transseptal puncture (TSP) for atrial fibrillation (AF) ablation. METHODS Consecutive patients undergoing AF ablation were prospectively included in the AF ablation registry and were analyzed according to single versus double TSP. RESULTS A total of 478 patients (female 35%, persistent AF 67%) undergoing AF ablation between 01/2014 and 09/2014 were included. Single TSP was performed in 202 (42%) patients, double TSP in 276 (58%) patients. Age, gender, body mass index, CHA2DS2-VASc score, left ventricular ejection fraction and operator experience (experienced operator defined as ≥ 5 years of experience in invasive electrophysiology) were equally distributed between the two groups. Repeat procedures (re-dos) were more frequently performed using single TSP access (p < 0.001). Left atrial (LA) diameter was larger in patients with double TSP (p = 0.001). Procedure duration in single TSP was identical to double TSP procedures (p = 0.823). Radiation duration was similar between the two groups (p = 0.217). There were 49 (10%) patients with complications after catheter ablation. There were no differences between complication rates and TSP type (p = 0.555). Similarly, recurrence rates were comparable between both TSP groups (p = 0.788). CONCLUSIONS There was no clear benefit of single or double TSP in AF ablation.
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Affiliation(s)
- Annina Stauber
- Department of Electrophysiology, Heart Center University Leipzig, Germany.
| | - Jelena Kornej
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | | | - Boris Dinov
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center University Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center University Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center University Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany.,Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum, Bad Oeynhausen, Germany
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Stauber A, Kornej J, Bollmann A, Hindricks G, Sommer P. Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 43:194-200. [PMID: 31853994 DOI: 10.1111/pace.13865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/05/2019] [Accepted: 12/11/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Thermolesions are a dangerous complication of atrial fibrillation (AF) ablation. We aimed to assess the reasons for thermolesions and the effect of esophageal position on recurrences. METHODS The study included consecutive patients undergoing AF catheter ablation at Heart Center Leipzig between January and September 2014. We collected data of esophagus localization, temperature, endoscopy, and follow-up. RESULTS The study included 645 patients into analyses. A total of 626 (97.2%) received a temperature probe. Esophageal position was categorized: (A) behind left pulmonary veins, (B) left ostial, (C) in the middle of left atrium, (D) right ostial, and (E) behind right pulmonary veins. The most frequent esophageal position was B-C (n = 201, 32.1%), followed by B (n = 161, 25.7%), and C (n = 147, 23.5%). The temperature was highest in A-B positions (42.04°C) and in D-E positions (41.70°C). There was a significant correlation between the endoscopically detected esophageal lesions (EDEL) and the esophageal position (r² = -.115, P = .004) and the esophageal temperature (r² = .162, P = .000), but not with body mass index (BMI) (r² = -.016, P = .688). Additional substrate modification in the left atrium resulted in significantly higher esophageal temperatures (P < .001) and more frequent EDEL (P = .049). An EDEL was found in 15 patients (2.3% of all patients, 5.6% of patients receiving endoscopy). Of those, the median esophageal temperature was 41.8°C (interquartile range [IQR]: 41.2-42.4). Neither esophageal position nor temperature during ablation was associated with arrhythmia recurrences (both P > .400). CONCLUSIONS EDEL depended on the esophageal position and temperature, but not on BMI. Esophageal position and intraluminal temperature during ablation had no effect on recurrences.
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Affiliation(s)
- Annina Stauber
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jelena Kornej
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Sommer
- Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum, Bad Oeynhausen, Germany
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Vevecka A, Schwab C, Forkmann M, Butz S, Issam A, Turschner O, Mahnkopf C, Brachmann J, Busch S. Predictive Factors and Safety of Noninvasive Mechanical Ventilation in Combination With Propofol Deep Sedation in Left Atrial Ablation Procedures. Am J Cardiol 2019; 124:233-238. [PMID: 31109635 DOI: 10.1016/j.amjcard.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 04/07/2019] [Accepted: 04/09/2019] [Indexed: 11/18/2022]
Abstract
Catheter ablation is nowadays the core treatment of atrial fibrillation (AF). Propofol infusion sedation is an accepted safety strategy; however, respiratory depression with respiratory variations is frequent. Noninvasive mechanical ventilation (NIV) added to deep sedation could improve procedural safety and success. We sought to assess the predictive factors and safety of NIV in combination to propofol deep sedation in left atrial ablation procedures. Procedural data from 252 consecutive patients who underwent left atrial ablation (166 [66%] persistent, 86 [34%] for paroxysmal AF) were analyzed. Sedation with 1% propofol was used in all procedures and controlled by electrophysiologists. Arterial blood gas analysis was performed regularly during the procedure. NIV was indicated for respiratory depression with pH <7.25 and pCO2 >50 mm Hg or agitated patient with the need for more profound sedation. No patient needed endotracheal intubation, and no procedure was abandoned due to adverse effects of sedation. NIV was used in 25 patients (10%). Predictive factors for the use of NIV were high-dose propofol sedation (p = 0.010), persistent AF (p = 0.029), prolonged procedure time (p = 0.006), increased body mass index (p = 0.008) and presence of obstructive sleep apnea (OSA; p <0.001). In a Cox regression analysis, OSA was an independent factor for NIV use (p = 0.016). In conclusion, propofol deep sedation for patients who underwent left atrial ablation is safe. Adding NIV in high-risk patients (i.e., OSA, high body mass index, and lengthy procedure duration) provides better respiratory homeostasis and could impact long-term procedure results.
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Affiliation(s)
- Aneida Vevecka
- Department of Cardiology, Angiology, and Pneumology, Coburg Hospital, Coburg, Germany.
| | - Carolina Schwab
- Department of Cardiology, Angiology, and Pneumology, Coburg Hospital, Coburg, Germany
| | - Mathias Forkmann
- Department of Cardiology, Angiology, and Pneumology, Coburg Hospital, Coburg, Germany
| | - Steffi Butz
- Department of Cardiology, Angiology, and Pneumology, Coburg Hospital, Coburg, Germany
| | - Ajmi Issam
- Department of Cardiology, Angiology, and Pneumology, Coburg Hospital, Coburg, Germany
| | - Oliver Turschner
- Department of Cardiology, Angiology, and Pneumology, Coburg Hospital, Coburg, Germany
| | - Christian Mahnkopf
- Department of Cardiology, Angiology, and Pneumology, Coburg Hospital, Coburg, Germany
| | - Johannes Brachmann
- Department of Cardiology, Angiology, and Pneumology, Coburg Hospital, Coburg, Germany
| | - Sonia Busch
- Department of Cardiology, Angiology, and Pneumology, Coburg Hospital, Coburg, Germany
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Bode K, Whittaker P, Lucas J, Müssigbrodt A, Hindricks G, Richter S, Doering M. Deep sedation for transvenous lead extraction: a large single-centre experience. Europace 2019; 21:1246-1253. [DOI: 10.1093/europace/euz131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/11/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Transvenous lead extraction for cardiac implantable electronic devices (CIED) is of growing importance. Nevertheless, the optimal anaesthetic approach, general anaesthesia vs. deep sedation (DS), remains unresolved. We describe our tertiary centre experience of the feasibility and safety of DS.
Methods and results
Extraction procedures were performed in the electrophysiology (EP) laboratory by two experienced electrophysiologists. We used intravenous Fentanyl, Midazolam, and Propofol for DS. A stepwise approach with locking stylets, dilator sheaths, and mechanical sheaths via subclavian, femoral, or internal jugular venous access was utilized. Patient characteristics and procedural data were collected. Logistic regression models were used to identify parameters associated with sedation-related complications. Extraction of 476 leads (dwelling time/patient 88 ± 49 months, 30% ICD leads) was performed in 220 patients (64 ± 17 years, 80% male). Deep sedation was initiated with bolus administration of Fentanyl, Midazolam, and Propofol; mean doses 0.34 ± 0.12 μg/kg, 24.3 ± 6.8 μg/kg, and 0.26 ± 0.13 mg/kg, respectively. Deep sedation was maintained with continuous Propofol infusion (initial dose 3.7 ± 1.1 mg/kg/h; subsequently increased to 4.7 ± 1.2 mg/kg/h with 3.9 ± 2.6 adjustments) and boluses of Midazolam and Fentanyl as indicated. Sedation-related episodes of hypotension, requiring vasopressors, and hypoxia, requiring additional airway management, occurred in 25 (11.4%) and 5 (2.3%) patients, respectively. These were managed without adverse consequences. Five patients (2.3%) experienced major intraprocedural complications; there were no procedure-related deaths. All of our logistic regression models indicated intraprocedural support was associated with administration higher Fentanyl doses.
Conclusion
Transvenous lead extraction under DS in the EP laboratory is a safe procedure with high success rates when performed by experienced staff.
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Affiliation(s)
- Kerstin Bode
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Peter Whittaker
- Department of Emergency Medicine, Cardiovascular Research Institute, Wayne State University, Detroit, MI, USA
| | - Johannes Lucas
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Andreas Müssigbrodt
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
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Kyriakopoulou M, Strisciuglio T, El Haddad M, De Pooter J, Almorad A, Van Beeumen K, Unger P, Vandekerckhove Y, Tavernier R, Duytschaever M, Knecht S. Evaluation of a simple technique aiming at optimizing point-by-point isolation of the left pulmonary veins: a randomized study. Europace 2019; 21:1185-1192. [DOI: 10.1093/europace/euz115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/02/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
We sought to evaluate the efficacy and the safety of a simple technique for stabilizing the ablation catheter during anterior pulmonary vein (PV) encirclement in patients ablated for paroxysmal atrial fibrillation. This consisted of bending the ablation catheter in the left atrium, creating a loop that was cautiously advanced together with the long sheath at the ostium and then within the left superior PV. The curve was then progressively released to reach a stable contact with the anterior part of the left PVs.
Methods and results
Eighty consecutive patients (age 64 ± 11 years, left atrial diameter 43 ± 8 mm) undergoing ‘CLOSE’-guided PV isolation were prospectively randomized into two groups depending on whether the loop technique was used or not. When using the loop technique, the encirclement of the left PVs was shorter [20 min (interquartile range, IQR 17–24) vs. 26 min (IQR 18–33), P < 0.01] with a high rate of first pass isolation [(100%) vs. (97%), P = 0.9] and adenosine proof isolation [(93%) vs. (95%), P = 0.67]. Most specifically, at the anterior part of the left PVs, there were less dislocations [0 (IQR 0–0) vs. 1 (IQR 0–4), P < 0.001], radiofrequency duration was shorter (272 ± 85 s vs. 378 ± 122 s, P < 0.001), force-time integral was higher [524 gs (IQR 427–687) vs. 398 gs (IQR 354–451), P < 0.001], average contact force was higher [20 g (IQR 13–27) vs. 11g (IQR 9–16), P < 0.001], and impedance drop was higher [12 Ω (IQR 9–19) vs. 10 Ω (IQR 7–14), P < 0.001].
Conclusion
This study describes a simple technique to facilitate catheter stability at the anterior part of the left PVs, resulting in more efficient left PV encirclement without compromising safety.
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Affiliation(s)
- Maria Kyriakopoulou
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
- Universite Libre de Bruxelles (ULB), Brussels, Belgium
| | - Teresa Strisciuglio
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Milad El Haddad
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Jan De Pooter
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
- Department of Cardiology, UZ Gent, Gent, Belgium
| | - Alexandre Almorad
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Katarina Van Beeumen
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | | | - Yves Vandekerckhove
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - René Tavernier
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Mattias Duytschaever
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
- Department of Cardiology, UZ Gent, Gent, Belgium
| | - Sébastien Knecht
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
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Paneque I, Calvo-Calvo MÁ, Rubio-Guerrero C, Frutos-López M, Arana-Rueda E, Pedrote A. Sedación profunda basada en propofol y administrada por electrofisiólogos en la ablación de la fibrilación auricular. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fujii S, Zhou JR, Dhir A. Anesthesia for Cardiac Ablation. J Cardiothorac Vasc Anesth 2018; 32:1892-1910. [DOI: 10.1053/j.jvca.2017.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Indexed: 12/19/2022]
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30
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Kaess BM, Feurich F, Bürkle G, Ehrlich JR. Midazolam addition to analgosedation for pulmonary vein isolation may increase risk of hypercapnia and acidosis. Int J Cardiol 2018; 259:100-102. [DOI: 10.1016/j.ijcard.2018.01.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/29/2017] [Accepted: 01/11/2018] [Indexed: 11/29/2022]
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Abstract
INTRODUCTION Procedural sedation is of paramount importance for a plethora of electrophysiological procedures. From electrical cardioversion to electrophysiology studies, device implantations, and catheter ablations, intraprocedural sedation and anesthesia have a pivotal role in allowing procedural success while ensuring patient safety and avoiding discomfort. Areas covered: The present review will discuss the current state-of-the-art in sedation and anesthesia during electrical cardioversion, cardiac implantable electronic device implantation, catheter ablation and electrophysiology studies. Specific information will be provided for each procedure in order to reach the core of this important clinical issue, and specific protocols will be compared. The main pro-arrhythmic and anti-arrhythmic effects of the most commonly used sedatives will also be discussed. Expert commentary: According to much recent evidence, the cardiologist can be the only person responsible for sedation administration in many settings, highlighting few safety issues associated with the absence of a dedicated anesthesiologist thus a concomitant reduction in costs. However, many concerns have been raised in allowing non-anesthesiologists to manage sedatives, as adverse events, while rare, could have catastrophic consequences. The present paper will highlight when a cardiologist-directed sedation is considered safe, how it should be performed, and the pros and cons related to this strategy.
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Affiliation(s)
- Federico Guerra
- a Cardiology and Arrhythmology Clinic , Marche Polytechnic University, University Hospital "Ospedali Riuniti" , Ancona , Italy
| | | | - Alessandro Capucci
- a Cardiology and Arrhythmology Clinic , Marche Polytechnic University, University Hospital "Ospedali Riuniti" , Ancona , Italy
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Yamaguchi T, Shimakawa Y, Mitsumizo S, Fukui A, Kawano Y, Otsubo T, Takahashi Y, Hirota K, Tsuchiya T, Eshima K. Feasibility of total intravenous anesthesia by cardiologists with the support of anesthesiologists during catheter ablation of atrial fibrillation. J Cardiol 2018; 72:19-25. [PMID: 29338895 DOI: 10.1016/j.jjcc.2017.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/08/2017] [Accepted: 12/13/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The optimal methodology for sedation and anesthesia during atrial fibrillation (AF) ablation has not been well established. We assessed the feasibility of total intravenous anesthesia (TIVA) by cardiologists with support from anesthesiologists during AF ablation and quality of pulmonary vein isolation (PVI) and single procedure success rate at 12 months. METHODS TIVA was performed by cardiologists using IV propofol and fentanyl under controlled ventilation via i-gel™ without neuromuscular blocking drugs in 160 consecutive patients (80 nonparoxysmal) with no anticipated difficult airway or other severe diseases. Anesthesiologists were requested to be on standby during the procedure. The incidence of anesthesia-associated complications and ablation-associated complications were assessed. To evaluate the quality of PVI, the prevalence of acute adenosine triphosphate (ATP)-provoked PV reconnections and late PV reconnections among those requiring a redo procedure was analyzed. RESULTS TIVA was successfully completed in 152 patients (95%). In five (3%), we requested help from anesthesiologists, and in three (2%), TIVA was abandoned. No major anesthesia-associated complications were observed. Ablation-associated complications were observed in seven patients (4%). ATP provocation test was performed in 141 patients, and no acute PV reconnections were observed in 134 (95%). Success rates at 12 months were 85% of patients off antiarrhythmic drugs. Twenty-one of 24 patients with recurrence underwent a redo session, and 18 (86%) had no PV reconnections. CONCLUSIONS TIVA by cardiologists with support from anesthesiologists during AF ablation may be feasible. The success rate at 12 months was high, and prevalence of acute and late PV reconnection was very low.
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Affiliation(s)
- Takanori Yamaguchi
- Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan.
| | - Yusuke Shimakawa
- Department of Anesthesiology, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Shinji Mitsumizo
- Department of Intensive Care Unit, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Akira Fukui
- EP Expert Doctors-Team Tsuchiya, Kumamoto, Japan
| | - Yuki Kawano
- Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan
| | | | | | - Kei Hirota
- EP Expert Doctors-Team Tsuchiya, Kumamoto, Japan
| | | | - Kenichi Eshima
- Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan
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Demystifying the EP Laboratory: Anesthetic Considerations for Electrophysiology Procedures. Int Anesthesiol Clin 2018; 56:98-119. [DOI: 10.1097/aia.0000000000000201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim DS, Na HS, Lee JH, Shin YD, Shim JK, Shin HW, Kang H, Joung KW. Current clinical application of dexmedetomidine for sedation and anesthesia. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.4.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Doo Sik Kim
- Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Hyo-seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Ji-hyang Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Young Duck Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyoseok Kang
- Department of Anesthesiology and Pain Medicine, Eulji Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Kyoung-Woon Joung
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Tilz RR, Chun KRJ, Deneke T, Kelm M, Piorkowski C, Sommer P, Stellbrink C, Steven D. Positionspapier der Deutschen Gesellschaft für Kardiologie zur Kardioanalgosedierung. KARDIOLOGE 2017. [DOI: 10.1007/s12181-017-0179-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Deep Sedation With Propofol Administered by Electrophysiologists in Atrial Fibrillation Ablation. ACTA ACUST UNITED AC 2017; 71:683-685. [PMID: 28757116 DOI: 10.1016/j.rec.2017.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/26/2017] [Indexed: 11/19/2022]
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Hida S, Takemoto M, Masumoto A, Mito T, Nagaoka K, Kumeda H, Kawano Y, Aoki R, Kang H, Tanaka A, Matsuo A, Hironaga K, Okazaki T, Yoshitake K, Tayama KI, Kosuga KI. Clinical benefits of deep sedation with a supraglottic airway while monitoring the bispectral index during catheter ablation of atrial fibrillation. J Arrhythm 2017; 33:283-288. [PMID: 28765758 PMCID: PMC5529590 DOI: 10.1016/j.joa.2017.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/24/2017] [Accepted: 04/02/2017] [Indexed: 11/18/2022] Open
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.
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Affiliation(s)
- Satoru Hida
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
| | - Masao Takemoto
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
- Correspondence to: Cardiovascular Center, Munakata Suikokai General Hospital, 5-7-1 Himakino, Fukutsu 811-3298, Japan. Fax: +81 940 34 3113.Cardiovascular Center, Munakata Suikokai General Hospital5-7-1 HimakinoFukutsu811-3298Japan
| | | | - Takahiro Mito
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
| | | | | | - Yuki Kawano
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
| | - Ryota Aoki
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
| | - Honsa Kang
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
| | - Atsushi Tanaka
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
| | - Atsutoshi Matsuo
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
| | | | - Teiji Okazaki
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
| | - Kiyonobu Yoshitake
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
| | - Kei-ichiro Tayama
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
| | - Ken-ichi Kosuga
- Cardiovascular Center, Munakata Suikokai General Hospital, Fukutsu, Japan
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Münkler P, Attanasio P, Parwani AS, Huemer M, Boldt LH, Haverkamp W, Wutzler A. High Patient Satisfaction with Deep Sedation for Catheter Ablation of Cardiac Arrhythmia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:585-590. [PMID: 28240366 DOI: 10.1111/pace.13063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 01/15/2017] [Accepted: 02/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients' satisfaction with invasive procedures largely relies on periprocedural perception of pain and discomfort. The necessity for intraprocedural sedation during catheter ablation of cardiac arrhythmias for technical reasons is widely accepted, but data on patients' experience of pain and satisfaction with the procedural sedation are scarce. We have assessed patients' pain and discomfort during and after the procedure using a standardized questionnaire. METHODS One hundred seventeen patients who underwent catheter ablation answered a standardized questionnaire on periprocedural perception of pain and discomfort after different anesthetic protocols with propofol/midazolam with and without additional piritramide and ketamine/midazolam. RESULTS Patients report a high level of satisfaction with periprocedural sedation with 83% judging sedation as good or very good. The majority of patients was unconscious of the whole procedure and did not recollect experiencing pain. Procedural pain was reported by 7.7% of the patients and 16% reported adverse effects, e.g., postprocedural nausea and episodes of headache. CONCLUSION The results of our study show that deep sedation during catheter ablation of cardiac arrhythmias is generally well tolerated and patients are satisfied with the procedure. Yet, a number of patients reports pain or adverse events. Therefore, studies comparing different sedation strategies should be conducted in order to optimize sedation and analgesia.
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Affiliation(s)
- Paula Münkler
- University Heart Center, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany
| | - Philipp Attanasio
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Abdul Shokor Parwani
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Martin Huemer
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Alexander Wutzler
- Department of Electrophysiology and Cardiac Rhythm Management, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität, Bochum, Germany
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Narui R, Matsuo S, Isogai R, Tokutake K, Yokoyama K, Kato M, Ito K, Tanigawa SI, Yamashita S, Tokuda M, Inada K, Shibayama K, Miyanaga S, Sugimoto K, Yoshimura M, Yamane T. Impact of deep sedation on the electrophysiological behavior of pulmonary vein and non-PV firing during catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2017; 49:51-57. [PMID: 28285382 DOI: 10.1007/s10840-017-0238-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 02/23/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Catheter ablation for atrial fibrillation is performed with and without deep sedation, which could affect the arrhythmogenic activity during the procedure. We investigated the impact of sedation on electrophysiological properties in patients with AF who underwent catheter ablation. METHODS This study consisted of 255 consecutive patients with atrial fibrillation (229 males, persistent: 105 patients) who underwent a single-catheter ablation procedure. The patients were divided into the following two groups according to the depth of sedation during the procedure: group M (mild sedation with flunitrazepam in 138 patients) and group D (deep sedation with propofol in 117 patients). Peripheral oxygen saturation was continuously monitored via pulse oximetry throughout the procedure. RESULTS A spontaneous dissociated pulmonary vein activity after pulmonary vein isolation occurred more frequently in group M than in group D (29.1 vs 15.7%, P < 0.01). Adenosine-induced dormant pulmonary vein conduction was more frequently observed in group M than in group D (19.2 vs 13.0% P = 0.01). There were no significant differences in the incidence of non-pulmonary vein triggers between groups M and D (15.2 vs 11.1%, P = 0.53). The atrial fibrillation recurrence rate following the single procedure did not differ between the two groups (29.0 vs 26.5%, in groups M and D, P = 0.85). CONCLUSIONS Although deep sedation reduced the incidence of a dissociated pulmonary vein activity and dormant pulmonary vein conduction following pulmonary vein isolation, it did not affect the recurrence rate for atrial fibrillation after the procedure.
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Affiliation(s)
- Ryohsuke Narui
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Seiichiro Matsuo
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ryota Isogai
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Yokoyama
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Mika Kato
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keiichi Ito
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shin-Ichi Tanigawa
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michifumi Tokuda
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Keiichi Inada
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenri Shibayama
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Satoru Miyanaga
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenichi Sugimoto
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michihiro Yoshimura
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Sawhney V, Bacuetes E, Wray M, Dhinoja M, Earley MJ, Schilling RJ, Sporton S. Moderate sedation in cardiac electrophysiology laboratory: a retrospective safety analysis. Heart 2017; 103:1210-1215. [PMID: 28249993 DOI: 10.1136/heartjnl-2016-310676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/30/2016] [Accepted: 01/27/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Cardiac electrophysiology (EP) procedures can be performed under moderate sedation without the direct involvement of an anaesthetist. However, concerns have been raised over the safety of this approach. This study examines the use of a standardised nurse-led physician-directed sedation protocol for EP procedures to determine the safety of moderate sedation administered by non-anaesthesia personnel who have been trained in sedation techniques. METHODS AND RESULTS Consecutive EP procedures done under moderate sedation over 12 years at our institution were evaluated. Serious adverse events were defined as (i) procedural death related to sedation; (ii) intubation and ventilation; and (iii) hypotension requiring inotropic support. Reversal of sedation constituted a minor adverse event. Up to 7117 procedures were included. These comprised ablations (55%), devices (43%) and other procedures (2%). A majority of patients were men with a mean age of 61±10 years. 99.98% of procedures were completed successfully without sedation-related serious adverse events. Two patients (0.02%) required anaesthetic support for intubation. Sedation was reversed in 1.2% of procedures with less than 1% requiring reversal because of persistent drop in oxygen saturation, hypoventilation or markedly reduced level of consciousness. There was no significant difference in the patient characteristics, mean doses of sedative agents and procedure types in the group requiring reversal of sedation when compared with the whole cohort. CONCLUSIONS Our study demonstrates that nurse-led, physician-directed moderate sedation is safe. Anaesthesia services are not required routinely for invasive cardiac EP procedures and should be available on a need basis.
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Affiliation(s)
- V Sawhney
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - E Bacuetes
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M Wray
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M Dhinoja
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M J Earley
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - R J Schilling
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - S Sporton
- Department of Cardiology, St Bartholomew's Hospital, London, UK
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Takigawa M, Takahashi A, Kuwahara T, Okubo K, Nakashima E, Watari Y, Yamao K, Nakajima J, Tanaka Y, Takagi K, Kimura S, Hikita H, Hirao K, Isobe M. Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation. J Arrhythm 2017; 33:262-268. [PMID: 28765755 PMCID: PMC5529327 DOI: 10.1016/j.joa.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/11/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022] Open
Abstract
Background The present study aimed to elucidate the safety and effectiveness of a noble and unique airway management technique in which a pediatric intubation tube is used in adult patients with atrial fibrillation (AF) undergoing catheter ablation (CA) under continuous deep sedation. Methods In total, 246 consecutive patients with AF (mean age, 65±10 years; 60 women) underwent CA under dexmedetomidine-based continuous deep sedation. A 4-mm pediatric intubation tube guided by a 10-French intratracheal suction tube was inserted smoothly, and the tip of the tube was located at the base of the epiglottis. The maximum shifting distance of the heart (MSDH) was measured with the 3D mapping system (Ensite NavX system) before and after inserting the pediatric intubation tube. Results At baseline, the MSDH of patients under continuous deep sedation was 23±14 mm. The pediatric intubation tube reduced the MSDH to 13±6 mm (mean reduction from baseline, 38.4±21.7%; P<0.0001). In contrast, oxygen saturation was significantly increased from 89±8% to 95±3% (P<0.0001). The mean distance between the nostril and base of the epiglottis was 16.6±0.5 mm. Major periprocedural complications occurred in 9 (3.6%) patients including 3 (1.2%) cardiac tamponade and 6 (2.4%) phrenic nerve injury cases. Larger MSDH (odds ratio, 1.13; 95% confidence interval, 1.04–1.25; P=0.007) was a significant predictor of major periprocedural complications. No major airway complications occurred, except in 3 patients (1.2%) who had minor nasal bleeding. Conclusion This unique airway management technique using a pediatric intubation tube for CA procedures performed in adult patients with AF under continuous deep sedation was easy, safe, and effective.
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Affiliation(s)
- Masateru Takigawa
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
- Heart Rhythm Centre, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- Corresponding author at: Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan. Fax: +81 46 825 2103.Cardiovascular Centre, Yokosuka Kyosai Hospital1-16 Yonegahama-StreetYokosuka238-8558Japan
| | - Atsushi Takahashi
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Taishi Kuwahara
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Kenji Okubo
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Emiko Nakashima
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Yuji Watari
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Kazuya Yamao
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Jun Nakajima
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Yasuaki Tanaka
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Katsumasa Takagi
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Shigeki Kimura
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Hiroyuki Hikita
- Cardiovascular Centre, Yokosuka Kyosai Hospital, 1-16 Yonegahama-Street, Yokosuka 238-8558, Japan
| | - Kenzo Hirao
- Heart Rhythm Centre, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Gerstein NS, Young A, Schulman PM, Stecker EC, Jessel PM. Sedation in the Electrophysiology Laboratory: A Multidisciplinary Review. J Am Heart Assoc 2016; 5:JAHA.116.003629. [PMID: 27412904 PMCID: PMC4937286 DOI: 10.1161/jaha.116.003629] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Andrew Young
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR
| | - Peter M Schulman
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Peter M Jessel
- Knight Cardiovascular Institute, VA Portland Health Care System, Portland, OR
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Conway A. A Review of the Effects of Sedation on Thermoregulation: Insights for the Cardiac Catheterization Laboratory. J Perianesth Nurs 2016; 31:226-36. [DOI: 10.1016/j.jopan.2014.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/10/2014] [Accepted: 07/31/2014] [Indexed: 12/21/2022]
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Sbrana F, Ripoli A, Formichi B. Anesthetic management in atrial fibrillation ablation procedure: Adding non-invasive ventilation to deep sedation. Indian Pacing Electrophysiol J 2016; 15:96-102. [PMID: 26937093 PMCID: PMC4750121 DOI: 10.1016/j.ipej.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Anesthetic management of patients undergoing pulmonary vein isolation for atrial fibrillation has specific requirements. The feasibility of non-invasive ventilation (NIV) added to deep sedation procedure was evaluated. Seventy-two patients who underwent ablation procedure were retrospectively revised, performed with (57%) or without (43%) application of NIV (Respironic® latex-free total face mask connected to Garbin ventilator-Linde Inc.) during deep sedation (Midazolam 0.01–0.02 mg/kg, fentanyl 2.5–5 μg/kg and propofol: bolus dose 1–1.5 mg/kg, maintenance 2–4 mg/kg/h). In the two groups (NIV vs deep sedation), differences were detected in intraprocedural (pH 7.37 ± 0.05 vs 7.32 ± 0.05, p = 0.001; PaO2 117.10 ± 27.25 vs 148.17 ± 45.29, p = 0.004; PaCO2 43.37 ± 6.91 vs 49.33 ± 7.34, p = 0.002) and in percentage variation with respect to basal values (pH −0.52 ± 0.83 vs −1.44 ± 0.87, p = 0.002; PaCO2 7.21 ± 15.55 vs 34.91 ± 25.76, p = 0.001) of arterial blood gas parameters. Two episodes of respiratory complications, treated with application of NIV, were reported in deep sedation procedure. Endotracheal intubation was not necessary in any case. Adverse events related to electrophysiological procedures and recurrence of atrial fibrillation were recorded, respectively, in 36% and 29% of cases. NIV proved to be feasible in this context and maintained better respiratory homeostasis and better arterial blood gas balance when added to deep sedation.
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Affiliation(s)
| | | | - Bruno Formichi
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; National Research Council, Institute of Clinical Physiology, Pisa, Italy
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Bollmann A, Hilbert S, John S, Kosiuk J, Hindricks G. Initial Experience With Ultra High-Density Mapping of Human Right Atria. J Cardiovasc Electrophysiol 2015; 27:154-60. [PMID: 26456153 DOI: 10.1111/jce.12852] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/10/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recently, an automatic, high-resolution mapping system has been presented to accurately and quickly identify right atrial geometry and activation patterns in animals, but human data are lacking. This study aims to assess the clinical feasibility and accuracy of high-density electroanatomical mapping of various RA arrhythmias. METHODS AND RESULTS Electroanatomical maps of the RA (35 partial and 24 complete) were created in 23 patients using a novel mini-basket catheter with 64 electrodes and automatic electrogram annotation. Median acquisition time was 6:43 minutes (0:39-23:05 minutes) with shorter times for partial (4.03 ± 4.13 minutes) than for complete maps (9.41 ± 4.92 minutes). During mapping 3,236 (710-16,306) data points were automatically annotated without manual correction. Maps obtained during sinus rhythm created geometry consistent with CT imaging and demonstrated activation originating at the middle to superior crista terminalis, while maps during CS pacing showed right atrial activation beginning at the infero-septal region. Activation patterns were consistent with cavotricuspid isthmus-dependent atrial flutter (n = 4), complex reentry tachycardia (n = 1), or ectopic atrial tachycardia (n = 2). His bundle and fractionated potentials in the slow pathway region were automatically detected in all patients. Ablation of the cavotricuspid isthmus (n = 9), the atrio-ventricular node (n = 2), atrial ectopy (n = 2), and the slow pathway (n = 3) was successfully and safely performed. CONCLUSIONS RA mapping with this automatic high-density mapping system is fast, feasible, and safe. It is possible to reproducibly identify propagation of atrial activation during sinus rhythm, various tachycardias, and also complex reentrant arrhythmias.
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Affiliation(s)
- Andreas Bollmann
- Department of Electrophysiology, Heart Center, Leipzig, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center, Leipzig, Leipzig, Germany
| | - Silke John
- Department of Electrophysiology, Heart Center, Leipzig, Leipzig, Germany
| | - Jedrzej Kosiuk
- Department of Electrophysiology, Heart Center, Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, Leipzig, Leipzig, Germany
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Bhatt HV, Syros G, Greco M, Miller M, Fischer GW. Ablation Therapy for Atrial Fibrillation: Implications for the Anesthesiologist. J Cardiothorac Vasc Anesth 2015; 29:1341-56. [DOI: 10.1053/j.jvca.2015.05.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Indexed: 11/11/2022]
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Hilbert S, Sommer P, Bollmann A. Pulmonary vein dilatation in a case of total pulmonary vein occlusion: Contemporary approach using a combination of 3D-mapping system and image integration. Catheter Cardiovasc Interv 2015; 88:E227-E232. [DOI: 10.1002/ccd.26251] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/07/2015] [Accepted: 09/06/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Sebastian Hilbert
- Department of Electrophysiology; University Leipzig-Heart Center; Leipzig Germany
| | - Philipp Sommer
- Department of Electrophysiology; University Leipzig-Heart Center; Leipzig Germany
| | - Andreas Bollmann
- Department of Electrophysiology; University Leipzig-Heart Center; Leipzig Germany
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Hilbert S, Sommer P, Gutberlet M, Gaspar T, Foldyna B, Piorkowski C, Weiss S, Lloyd T, Schnackenburg B, Krueger S, Fleiter C, Paetsch I, Jahnke C, Hindricks G, Grothoff M. Real-time magnetic resonance-guided ablation of typical right atrial flutter using a combination of active catheter tracking and passive catheter visualization in man: initial results from a consecutive patient series. Europace 2015; 18:572-7. [DOI: 10.1093/europace/euv249] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 06/15/2015] [Indexed: 11/13/2022] Open
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Furniss SS, Sneyd JR. Safe sedation in modern cardiological practice. Heart 2015; 101:1526-30. [DOI: 10.1136/heartjnl-2015-307656] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/28/2015] [Indexed: 11/03/2022] Open
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Ichihara N, Miyazaki S, Taniguchi H, Usui E, Takagi T, Iwasawa J, Kuroi A, Nakamura H, Hachiya H, Iesaka Y. Simple Minimal Sedation for Catheter Ablation of Atrial Fibrillation. Circ J 2015; 79:346-50. [DOI: 10.1253/circj.cj-14-1106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Eisuke Usui
- Cardiovascular Center, Tsuchiura Kyodo Hospital
| | | | - Jin Iwasawa
- Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Akio Kuroi
- Cardiovascular Center, Tsuchiura Kyodo Hospital
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