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Jimenez-Candil J, Hernandez Hernandez J, Cruz Galban A, Blanco F, Moriñigo JL, Sanchez García M, Oterino A, Sanchez PL. Clinical and economic outcomes of a systematic same-day discharge programme after pulmonary vein isolation: comparison between cryoballoon vs. radiofrequency ablation. Europace 2023; 25:euad265. [PMID: 37669318 PMCID: PMC10498138 DOI: 10.1093/europace/euad265] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023] Open
Abstract
AIMS Same-day discharge (SDD) is feasible after pulmonary vein isolation (PVI). We aim to compare prospectively cryoballoon (CRYO) vs. radiofrequency (RF) ablation in a systematic SDD programme. METHODS AND RESULTS We prospectively analysed the 617 scheduled PVI performed consecutively at our institution (n = 377 CRYO, n = 240 RF) from 1 April 2019 to 31 December 2022 within a systematic programme of SDD. The feasibility of SDD, the 10-day incidence of urgent/unplanned medical care after discharge (UUC-10), and the cost per procedure due to hospital resource use were studied. The 100 procedures performed during the previous year, in which patients were systematically hospitalized, were used as a control group. Same-day discharge was achieved in 585/617 (95%) procedures, with a significant trend towards a higher monthly SDD rate from 2019 to 2022 (P = 0.03). The frequency of SDD was similar in CRYO (356/377; 94%) vs. RF (229/240; 95%). After SDD, the UUC-10 was 66/585 (11.3%), being similar for CRYO (41/356; 11.5%) and RF (25/229; 10.9%); P = 0.8 (log-rank test). Of these, 10 patients were re-hospitalized, with an identical rate in CRYO-treated (6/356; 1.7%) and RF-treated (4/229; 1.7%) patients and owing to similar causes (4 haematomas, 4 pericarditis, and 2 symptomatic sinus node dysfunction). Same-day discharge was associated with an average savings per procedure of 63% (P < 0.001), but no differences were found between the CRYO and RF (P = 0.8). CONCLUSION In a systematic SDD programme, feasibility (95%, increasing over time), safety (11% UUC-10, 1.7% re-hospitalizations), and savings (63% per procedure) were similar for CRYO and RF ablation procedures.
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Affiliation(s)
- Javier Jimenez-Candil
- Servicio de Cardiología, IBSAL-Hospital Universitario, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- CIBER-CV
- Universidad de Salamanca, Salamanca, Spain
| | - Jesus Hernandez Hernandez
- Servicio de Cardiología, IBSAL-Hospital Universitario, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
| | - Alba Cruz Galban
- Servicio de Cardiología, IBSAL-Hospital Universitario, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
| | - Fabian Blanco
- Servicio de Cardiología, IBSAL-Hospital Universitario, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
| | - Jose Luis Moriñigo
- Servicio de Cardiología, IBSAL-Hospital Universitario, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- Universidad de Salamanca, Salamanca, Spain
| | - Manuel Sanchez García
- Servicio de Cardiología, IBSAL-Hospital Universitario, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
| | - Armando Oterino
- Servicio de Cardiología, IBSAL-Hospital Universitario, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
| | - Pedro L Sanchez
- Servicio de Cardiología, IBSAL-Hospital Universitario, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
- CIBER-CV
- Universidad de Salamanca, Salamanca, Spain
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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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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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Gallego-Ligorit L, Vives M, Vallés-Torres J, Sanjuán-Villarreal TA, Pajares A, Iglesias M. Use of Dexmedetomidine in Cardiothoracic and Vascular Anesthesia. J Cardiothorac Vasc Anesth 2017; 32:1426-1438. [PMID: 29325842 DOI: 10.1053/j.jvca.2017.11.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 12/16/2022]
Abstract
Dexmedetomidine is a highly selective α2-adrenergic agonist with analgesic and sedative properties. In the United States, the Food and Drug Administration approved the use of the drug for short-lasting sedation (24 h) in intensive care units (ICUs) in patients undergoing mechanical ventilation and endotracheal intubation. In October 2008, the Food and Drug Administration extended use of the drug for the sedation of nonintubated patients before and during surgical and nonsurgical procedures. In the European Union, the European Medicine Agency approved the use of dexmedetomidine in September 2011 with a single recognized indication: ICU adult patients requiring mild sedation and awakening in response to verbal stimulus. At present, the use of dexmedetomidine for sedation outside the ICU remains an off-label indication. The benefits of dexmedetomidine in critically ill patients and in cardiac, electrophysiology-related, vascular, and thoracic procedures are discussed.
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Affiliation(s)
- Lucía Gallego-Ligorit
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Marc Vives
- Department of Anesthesiology and Critical Care Medicine, Hospital de Bellvitge, Barcelona, Spain
| | - Jorge Vallés-Torres
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - T Alberto Sanjuán-Villarreal
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Azucena Pajares
- Department of Anesthesiology and Critical Care Medicine, Cardiovascular and Thoracic Anesthesia Section,Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Mario Iglesias
- Department of Anesthesiology and Reanimation, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón. (IiSGM), Madrid, Spain
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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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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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Miyazaki S, Kuroi A, Hachiya H, Nakamura H, Taniguchi H, Ichihara N, Takagi T, Iwasawa J, Iesaka Y. Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies - Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation. Circ J 2015; 80:346-53. [PMID: 26638872 DOI: 10.1253/circj.cj-15-1051] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammation plays a prominent role in the etiology of the early recurrence of atrial fibrillation (ERAF). We prospectively compared the proportion of ERAF and time-course patterns of biomarkers between radiofrequency (RF) and cryoballoon (CB) ablation. METHODS AND RESULTS We enrolled 82 consecutive paroxysmal AF patients undergoing pulmonary vein (PV) isolation, performed with either a 28-mm 2nd-generation CB and 3-min freeze technique or point-by-point RF ablation. Each group had 41 patients. In the RF group, all PVs were successfully isolated with 28.9 ± 6.5 min of RF delivery. In the CB group, a mean of 5.3 ± 1.4 applications/patient was delivered. The proportion of ERAF was similar between the groups. The time-course patterns significantly differed between the groups for high-sensitivity C-reactive protein (hs-CRP) value (P=0.006) and myocardial injury markers (P<0.0001). Greater myocardial injury was observed in the CB than in the RF group (P<0.0001), whereas the peak hs-CRP value was comparable between the groups. The 2-day post-procedure hs-CRP value was the sole factor correlating with ERAF as identified by the multivariable analysis (hazard ratio 1.697; 95% confidence interval, 1.005-2.865; P=0.048) in the RF, but not the CB group. CONCLUSIONS The proportion of ERAF was comparable after RF and 2nd-generation CB ablation. Despite CB ablation exhibiting greater myocardial injury than RF ablation, the inflammatory responses were comparable between the groups. The inflammatory response extent predicted ERAF post-RF ablation but not post-CB ablation.
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Affiliation(s)
- Shinsuke Miyazaki
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital
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