Deep sedation in patients undergoing atrioventricular nodal reentry tachycardia ablation

Abstract

Background:General anesthesia and deep sedation can be used during cardiac EPS to relief pain and provide comfort and immobility, but many electrophysiologists avoid sedation for better arrhythmia induction.Objective:To determine anesthesia effects in ablation procedures in adults, we used intravenous anesthetic agents in patients who underwent slow pathway ablation.Patients and Methods:One hundred patients who were to undergo radiofrequency catheter ablation were randomly assigned to with and without intravenous anesthesia groups. All patients had palpitation with a documented electrocardiography (ECG) compatible with atrio-ventricular nodal reentrant tachycardia (AVNRT). We used propofol, fentanyl and midazolam for intravenous sedation. Electrophysiological parameters were checked for the two groups and compared before and after the ablation.Results:Electrophysiological parameters were not significantly different in the two groups. In the anesthetic group, patients were more satisfied with the procedure (P value < 0. 001).Conclusions:Intravenous anesthesia could be done safely in patients who underwent electrophysiological procedures. It had no effect on arrhythmia induction or slow pathway ablation in patients with documented AVNRT.

Arrhythmia induction using isoproterenol or epinephrine during electrophysiology study for supraventricular tachycardia

“…[9][10][11][12][13][14][15][16] Even under conditions of deep sedation or general anesthesia, isoproterenol is effective for arrhythmia induction. 17 However, as noted in prior publications, 18 a dramatic price increase in March 2015 19 resulted in the wholesale acquisition cost of isoproterenol increasing from $26.20 to $1,790.11 per milligram. The nonspecific alpha-and beta-adrenergic stimulant, epinephrine (priced at $14.96 per milligram), is an alternative to isoproterenol.…”

“…To date, the largest series of cases involving tilt table testing, EPS and supraventricular tachycardia (SVT) ablation, and premature ventricular contraction ablation have all used isoproterenol as the primary provocative drug . Even under conditions of deep sedation or general anesthesia, isoproterenol is effective for arrhythmia induction . However, as noted in prior publications, a dramatic price increase in March 2015 resulted in the wholesale acquisition cost of isoproterenol increasing from $26.20 to $1,790.11 per milligram.…”

Outcomes of deep sedation for catheter ablation of paroxysmal supraventricular tachycardia, with adaptive servo ventilation

“…24,25 In our study, the combination of dexmedetomidine and propofol enabled us to achieve both preserved inducibility and a safe procedure without complications related to deep sedation. 19 Utility of propofol in catheter ablation for AVNRT has been described in the past, 24,26 but we evaluated the inducibility and the outcome not only for AVNRT but also for other types of PSVT, and under deep sedation with ASV instead of minimal sedation.…”

Ultrasound is a new and reliable technique for central venous cannulation

“…Therefore, major studies have indicated the application of sonographic guided cannulation for central venous catheterization ( 14 ). Some evidence-based studies suggested good clinical outcomes for central venous catheterization for vascular access in neonates, infants and for arterial catheterization.…”