Improved sedation with dexmedetomidine-remifentanil compared with midazolam-remifentanil during catheter ablation of atrial fibrillation: a randomized, controlled trial

Cho, Jin Sun; Shim, Jæ Kwang; Na, Sungwon; Park, Inhye; Kwak, Young Lan

doi:10.1093/europace/eut365

Cited by 45 publications

(50 citation statements)

References 29 publications

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“…Incidence of hypotension events tended to be higher with dexmedetomidine (21% vs. 9%) without statistical significance. Cho et al also reported superior efficacy and safety of dexmedetomidine and remifentanil compared to midazolam and remifentanil in a randomized study including 90 patients undergoing AF ablation [14]. In this study performed by anesthesiologists, the dexmedetomidine group showed a lower incidence of respiratory depression, a lower pain score, a higher satisfaction level of interventionists, and a nonsignificantly higher incidence of hypotension (mean arterial pressure < 60 mmHg: 11.1% vs. 0%, p = 0.056).…”

Section: Discussionmentioning

confidence: 71%

“…Furthermore, a significantly higher number of patients in the dexmedetomidine group needed intravenous inotropic agent administration due to adverse hypotensive events. Although direct comparison of the incidence of adverse hemodynamic events to previous studies is limited due to different definitions of adverse events, the trend of higher incidence of hypotension with dexmedetomidine in patients undergoing AF ablation has been consistently shown in previous studies [14,15,23].…”

Section: Discussionmentioning

confidence: 92%

“…It causes less respiratory depression [8,9], and its efficacy and safety have been established in many previous studies for various clinical applications, including non-intubated invasive procedures [10][11][12][13]. However, its application to AF ablation has only been reported in relatively small randomized trials [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Randomized comparison between dexmedetomidine–remifentanil and midazolam–fentanyl for deep sedation during catheter ablation of atrial fibrillation

Choi

Kim

et al. 2019

Int J Arrhythm

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Background and objectives: The efficacy of dexmedetomidine for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has not been well established. We evaluated the efficacy and safety of sedation using dexmedetomidine with remifentanil compared to conventional sedative agents during RFCA for AF. Subjects and methods: A total of 240 patients undergoing RFCA for AF were randomized to either the dexmedetomidine (DEX) group (continuous infusion of dexmedetomidine and remifentanil) or the midazolam (MID) group (intermittent injections of midazolam and fentanyl) according to sedative agents. Non-invasive positive pressure ventilation was applied to all patients during the procedure. The primary outcome was patient movement during the procedure resulting in a 3D mapping system discordance, and the secondary outcome was adverse events including respiratory or hemodynamic compromise. Results: During AF ablation, the incidence of the primary outcome was significantly reduced for the DEX group (18.2% vs. 39.5% in the DEX and the MID groups, respectively, p < 0.001). The frequency of a desaturation event (oxygen saturation < 90%) did not significantly differ between the two groups (6.6% vs. 1.7%, p = 0.056). However, the incidences of hypotension not owing to cardiac tamponade (systolic blood pressure < 80 mmHg, 19.8% vs. 8.4%, p = 0.011) and bradycardia (HR < 50 beats/min: 39.7% vs. 21.8%, p = 0.003) were higher in the DEX group. All efficacy and safety results were consistent within the predefined subgroups. Conclusion: The combined use of dexmedetomidine and remifentanil provides higher stability sedation during AF ablation, but can lead to more frequent hemodynamic compromise compared to midazolam and fentanyl.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 92%

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Randomized comparison between dexmedetomidine–remifentanil and midazolam–fentanyl for deep sedation during catheter ablation of atrial fibrillation

Choi

Kim

et al. 2019

Int J Arrhythm

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“…Irrespective of this compromise, the pattern of complications did not deviate largely from the safety profile of the sedatives that were commonly used for each procedure. For example, DEX induces sedation by sympatholytic effects through stimulation of α 2A -adrenoceptors in the locus ceruleus, resulting in a minimized risk for respiratory depression to a greater extent than other sedatives, including PF [21], MDZ [21, 24], and TIA [25]. By increasing parasympathetic activity, however, DEX induces bradycardia.…”

Section: Discussionmentioning

confidence: 99%

Recent Trends in the Practice of Procedural Sedation Under Local Anesthesia for Catheter Ablation, Gastrointestinal Endoscopy, and Endoscopic Surgery in Japan: A Retrospective Database Study in Clinical Practice from 2012 to 2015

Matsui

Morimoto

Suzuki

et al. 2018

Drugs - Real World Outcomes

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ObjectivesTo investigate changes in sedation practice during 2012–2015, using a large health claims database, for catheter ablation (CA), gastrointestinal endoscopic examination (EE), and surgery (ES) after dexmedetomidine (DEX) was approved for procedural sedation in 2013. We assessed the trends of sedative utilization, sedative-analgesic combinations, and, additionally, incidence of complications from 2012 to 2015.MethodsUsing the database provided by Medical Data Vision Co., Ltd. (Tokyo, Japan), annual utilization proportions of the sedatives and sedative-analgesic combinations and occurrence of complications were calculated in patients with a record of local anesthesia and CA, EE, and/or ES but without general anesthesia used on the same day. The sedatives studied were DEX, propofol (PF), midazolam (MDZ), diazepam, flunitrazepam, thiamylal (TIA), thiopental (TIO), and ketamine.ResultsDEX was used most often for CA, followed by PF. From 2012 to 2015, the proportion of DEX increased from 30 to 36%, and that of PF slightly decreased from 29 to 27%. The order of utilization proportions did not change for EE or ES. The use of benzodiazepines, particularly MDZ, predominated. The top five sedative-analgesic combination patterns changed during the study period for CA, but not for EE or ES. The most common complications with CA, EE, and ES were bradycardia, nausea and vomiting, and respiratory depression, respectively. There were no changes in the complications’ trends for the procedures.ConclusionThe approved use of DEX for procedural sedation resulted in changes for CA, but not for EE or ES. The complication trends did not change.Electronic supplementary materialThe online version of this article (10.1007/s40801-018-0136-y) contains supplementary material, which is available to authorized users.

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“…48 Sedation reduces patient discomfort and can result in shorter and more effective procedures. To operate under sedation, the intervention room set up requires basic anesthesia equipment, for example, ventilator, vital signs recorders (PO 2 , blood pressure, respiration), and ECG monitors.…”

Section: Sedationmentioning

confidence: 99%

Interventional Cardiac Magnetic Resonance Imaging in Electrophysiology

Bhagirath

Graaf

Karim

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Improved sedation with dexmedetomidine-remifentanil compared with midazolam-remifentanil during catheter ablation of atrial fibrillation: a randomized, controlled trial

Abstract: The combination of dexmedetomidine and remifentanil provided deeper sedation, less respiratory depression, better analgesia, and higher satisfaction for the interventionist during catheter ablation of A-fib compared with midazolam plus remifentanil, even at a lower dose of remifentanil.

Cited by 45 publications

References 29 publications

Randomized comparison between dexmedetomidine–remifentanil and midazolam–fentanyl for deep sedation during catheter ablation of atrial fibrillation

Randomized comparison between dexmedetomidine–remifentanil and midazolam–fentanyl for deep sedation during catheter ablation of atrial fibrillation

Recent Trends in the Practice of Procedural Sedation Under Local Anesthesia for Catheter Ablation, Gastrointestinal Endoscopy, and Endoscopic Surgery in Japan: A Retrospective Database Study in Clinical Practice from 2012 to 2015

Interventional Cardiac Magnetic Resonance Imaging in Electrophysiology

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