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Minciună IA, Tomoaia R, Suceveanu M, Cismaru G, Puiu M, Roșu R, Simu G, Irimie DA, Frîngu F, Caloian B, Andronache M, Zdrenghea D, Pop D. General Anesthesia Improves Efficiency of High-Power Short-Duration Catheter Ablation for Atrial Fibrillation: Comparison with Mild Conscious Sedation. J Pers Med 2024; 14:865. [PMID: 39202056 PMCID: PMC11355396 DOI: 10.3390/jpm14080865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/28/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia globally. High-power, short-duration radiofrequency (RF) catheter ablation (CA) for AF has recently emerged, reducing ablation times and enhancing patient tolerability with comparable efficacy and safety. While the benefits of general anesthesia (GA) for standard-power, standard-duration CA are well-established, data comparing GA to mild conscious sedation (MCS) for high-power, short-duration CA are limited. METHODS We included patients undergoing high-power, short-duration CA for AF under GA (group 1) or MCS (group 2). Procedural characteristics, success rates, and mid-term outcomes were compared. RESULTS In total, 131 patients, 47 in the GA group and 84 in the MCS group, were included. CA was performed for paroxysmal AF in 34 patients in group 1 (72.3%) and 68 patients in group 2 (80.9%). We found lower a mean total procedure time (100 [90-120] vs. 160 [130-180] min, p < 0.0001), lower radiation exposure (932.5 [625-1716] vs. 2445 [1228-4791] μGy, p < 0.0001 and 4.5 [3-7.1] 7.3 [4.2-13.5] min, p = 0.0003) and fewer RF applications (71 [54.8-83.8] vs. 103 [88.5-120.5], p < 0.0001) in the GA group. No major complications occurred. The 6-month AF recurrence rate was comparable between the groups (21.2% vs. 33.3%, p = 0.15). CONCLUSION In patients undergoing high-power, short-duration RFCA for AF, the use of GA is associated with better procedural efficiency while simultaneously associated with an early recurrence rate comparable to MCS.
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Affiliation(s)
- Ioan-Alexandru Minciună
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (R.R.); (G.S.); (D.A.I.); (F.F.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
| | - Raluca Tomoaia
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (R.R.); (G.S.); (D.A.I.); (F.F.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
| | - Mihai Suceveanu
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
| | - Gabriel Cismaru
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (R.R.); (G.S.); (D.A.I.); (F.F.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
| | - Mihai Puiu
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
| | - Radu Roșu
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (R.R.); (G.S.); (D.A.I.); (F.F.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
| | - Gelu Simu
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (R.R.); (G.S.); (D.A.I.); (F.F.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
| | - Diana Andrada Irimie
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (R.R.); (G.S.); (D.A.I.); (F.F.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
| | - Florina Frîngu
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (R.R.); (G.S.); (D.A.I.); (F.F.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
| | - Bogdan Caloian
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (R.R.); (G.S.); (D.A.I.); (F.F.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
| | | | - Dumitru Zdrenghea
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (R.R.); (G.S.); (D.A.I.); (F.F.); (B.C.); (D.Z.); (D.P.)
| | - Dana Pop
- 5th Department of Internal Medicine, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (R.R.); (G.S.); (D.A.I.); (F.F.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania; (M.S.); (M.P.)
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Iacopino S, Filannino P, Artale P, Petretta A, Colella J, Statuto G, Di Vilio A, Dini D, Mantovani L, Rago A, Sorrenti PF, Fabiano G, Campagna G, Fabiano E, Malacrida M, Cecchini F. Investigating Deep Sedation With Intravenous Ketamine in Spontaneous Respiration During Pulsed-Field Ablation. J Cardiothorac Vasc Anesth 2024; 38:148-154. [PMID: 37953172 DOI: 10.1053/j.jvca.2023.10.024] [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: 08/16/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES The authors report their experience of a protocol for deep sedation with ketamine in spontaneous respiration during the pulsed-field ablation (PFA) of atrial fibrillation (AF). DESIGN Observational, prospective, nonrandomized fashion. SETTING Single-center hospitalized patients. PARTICIPANTS All consecutive patients undergoing PFA of AF. INTERVENTIONS Patients undergoing deep sedation with intravenous ketamine. MEASUREMENTS AND MAIN RESULTS The authors' sedation protocol involves the intravenous administration of fentanyl (1.5 µg/kg) and midazolam (2 mg) at low doses before local anesthesia with lidocaine. A ketamine adjunct (1 mg/kg) in 5-minute boluses was injected about 5 minutes before the first PFA delivery. The authors enrolled 117 patients (age = 59 ± 10 y, 74.4% males, body mass index = 27.6 ± 5 kg/m2, fluoroscopy time = 24 ± 14 minutes, skin-to-skin time = 80 ± 40 minutes and PFA LA dwell time = 24 ± 7 minutes). By the end of the procedure, pulmonary vein isolation had been achieved in all patients using PFA alone. The mean time under sedation was 54.9 ± 6 minutes, with 92 patients (79%) being sedated for <1 hour. A satisfactory Ramsay Sedation Scale level before ketamine administration was achieved in all patients, except one (80.3% of the patients with rank 3; 18.4% with rank 2). In all procedures, the satisfaction level was found acceptable by both the patient and the primary operator (satisfactory in 98.2% of cases). All patients achieved a Numeric Rating Scale for Pain ≤3 (none or mild). No major procedure or anesthesia-related complications were reported. CONCLUSION The authors' standardized sedation protocol with the administration of drugs with rapid onset and pharmacologic offset at low doses was safe and effective, with an optimal degree of patient and operator satisfaction.
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Shah MM, Liang JJ, Huntrakul A. Optimal anesthesia approach during catheter ablation of premature ventricular complexes: you snooze, you lose! J Interv Card Electrophysiol 2023; 66:1969-1970. [PMID: 37354368 DOI: 10.1007/s10840-023-01584-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Muazzum M Shah
- Electrophysiology Section, Division of Cardiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Jackson J Liang
- Electrophysiology Section, Division of Cardiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Anurut Huntrakul
- Electrophysiology Section, Division of Cardiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University and Cardiac Center, Bangkok, Thailand.
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Iacopino S, Colella J, Dini D, Mantovani L, Sorrenti PF, Malacrida M, Filannino P. Sedation strategies for pulsed-field ablation of atrial fibrillation: focus on deep sedation with intravenous ketamine in spontaneous respiration. Europace 2023; 25:euad230. [PMID: 37494101 PMCID: PMC10434732 DOI: 10.1093/europace/euad230] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/20/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
AIMS A standardized sedation protocol for pulsed-field ablation (PFA) of atrial fibrillation (AF) through irreversible cellular electroporation has not been well established. We report our experience of a protocol for deep sedation with ketamine in spontaneous respiration during the PFA of AF. METHODS AND RESULTS All consecutive patients undergoing PFA for AF at our center were included. Our sedation protocol involves the intravenous administration of fentanyl (1.5 mcg/kg) and midazolam (2 mg) at low doses before local anesthesia with lidocaine. A ketamine adjunct (1 mg/kg) was injected about 5 minutes before the first PFA delivery. We enrolled 66 patients (age = 59 ± 9 years, 78.8% males, body mass index = 28.8 ± 5 kg/m2, fluoroscopy time = 21[15-30] min, skin-to-skin time = 75[60-100] min and PFA LA dwell time = 25[22-28] min). By the end of the procedure, PVI had been achieved in all patients by means of PFA alone. The mean time under sedation was 56.4 ± 6 min, with 50 (76%) patients being sedated for less than 1 hour. A satisfactory Ramsey Sedation Scale level before ketamine infusion was achieved in all patients except one (78.8% of the patients with rank 3; 19.7% with rank 2). In all procedures, the satisfaction level was found to be acceptable by both the patient and the primary operator (Score = 0 in 98.5% of cases). All patients reported none or mild pain. No major procedure or anesthesia-related complications were reported. CONCLUSION Our standardized sedation protocol with the administration of drugs with rapid onset and pharmacological offset at low doses was safe and effective, with an optimal degree of patient and operator satisfaction. CLINICAL TRIAL REGISTRATION Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA). URL: http://clinicaltrials.gov/Identifier: NCT05617456.
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Affiliation(s)
- Saverio Iacopino
- Electrophysiology Unit, GVM Care&Research, Maria Cecilia Hospital, Cotignola, 48033 RA, Italy
| | - Jacopo Colella
- Electrophysiology Unit, GVM Care&Research, Maria Cecilia Hospital, Cotignola, 48033 RA, Italy
| | - Daniele Dini
- Electrophysiology Unit, GVM Care&Research, Maria Cecilia Hospital, Cotignola, 48033 RA, Italy
| | - Lorenzo Mantovani
- Electrophysiology Unit, GVM Care&Research, Maria Cecilia Hospital, Cotignola, 48033 RA, Italy
| | | | - Maurizio Malacrida
- Medical Education & Scientific Affairs, Boston Scientific, 20134, Milan, Italy
| | - Pasquale Filannino
- Electrophysiology Unit, GVM Care&Research, Maria Cecilia Hospital, Cotignola, 48033 RA, Italy
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Cooper J, Joseph C, Zagrodzky J, Woods C, Metzl M, Turer RW, McDonald SA, Kulstad E, Daniels J. Active esophageal cooling during radiofrequency ablation of the left atrium: data review and update. Expert Rev Med Devices 2022; 19:949-957. [PMID: 36413154 PMCID: PMC9839561 DOI: 10.1080/17434440.2022.2150930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Radiofrequency (RF) ablation of the left atrium of the heart is increasingly used to treat atrial fibrillation (AF). Unfortunately, inadvertent thermal injury to the esophagus can occur during this procedure, potentially creating an atrioesophageal fistula (AEF) which is 80% fatal. The ensoETM (Attune Medical, Chicago, IL), is an esophageal cooling device that has been shown to reduce thermal injury to the esophagus during RF ablation. AREAS COVERED This review summarizes growing evidence related to active esophageal cooling during RF ablation for the treatment of AF. The review presents data demonstrating improved outcomes related to patient safety and procedural efficiency and suggests directions for future research. EXPERT OPINION The use of active esophageal cooling during RF ablation reduces esophageal injury, reduces or eliminates fluoroscopy requirements, reduces procedure duration and post-operative pain, and increases long-term freedom from arrhythmia. These effects in turn increase patient same-day discharge rates, decrease operator cognitive load, and reduce cost. These findings are likely to further accelerate the adoption of active esophageal cooling.
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Affiliation(s)
- Julie Cooper
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | | | - Jason Zagrodzky
- Texas Cardiac Arrhythmia Institute, St. David’s South Austin Medical Center, Austin, TX 78704
| | | | - Mark Metzl
- NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL 60201
| | - Robert W. Turer
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | | | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - James Daniels
- University of Texas Southwestern Medical Center, Dallas, TX 75390
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