Moderate Sedation Reduces Lab Time Compared to General Anesthesia during Cryoballoon Ablation for AF Without Compromising Safety or Long‐Term Efficacy

Wasserlauf, Jeremiah; Knight, Bradley P.; Li, Zhi; Andrei, Adin Cristian; Arora, Rishi; Chicos, Alexandru B.; Goldberger, Jeffrey J.; Kim, Susan S.; Lin, Albert; Verma, Nishant; Bohn, Martha; Passman, Rod

doi:10.1111/pace.12961

Cited by 31 publications

(23 citation statements)

References 19 publications

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“…EAM, electroanatomical mapping associated complications and arrhythmia recurrence [9,14]. For the single-shot cryoballoon technique, immobilization is less essential and no differences in arrhythmia recurrence or complication rates were found comparing moderate sedation and general anesthesia [3,6]. Common cardiovascular risk factors and associated diseases such as obesity, smoking, sleep apnea or chronic obstructive lung disease (COPD) affect the respiratory system and could affect sedation [15].…”

Section: Discussionmentioning

confidence: 99%

“…macroreentrant, microreentrant or focal atrial tachycardia, require electroanatomical mapping and therefore generally are treated by 3D-mapping guided point-by-point radiofrequency catheter ablation [1]. Most electrophysiological procedures can be performed under conscious moderate to deep sedation [4][5][6]. Immobilization of patients during long-lasting procedures is required to avoid complications by patients' unexpected bodily motion [7].…”

Section: Introductionmentioning

confidence: 99%

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Safety of conscious sedation in electroanatomical mapping procedures and cryoballoon pulmonary vein isolation

et al. 2020

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety of conscious sedation in electroanatomical mapping procedures and cryoballoon pulmonary vein isolation

et al. 2020

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“…Prior work by our group and others has demonstrated cryoballoon ablation (CBA) for pulmonary vein isolation (PVI) to be associated with shorter procedure time, comparable clinical success rates, 4‐8 and significantly less pain 1,9 than radiofrequency ablation. CBA may be performed using moderate sedation (MS) rather than general anesthesia (GA) in patients who do not have a high‐risk airway or other medical indication for GA. MS avoids the risks associated with endotracheal intubation and the additional monitoring often required, as well as reduces total electrophysiology (EP) lab utilization time without compromising freedom from AF 10 . However, data comparing patient comfort and satisfaction between sedation modalities in CBA are lacking.…”

Section: Introductionmentioning

confidence: 99%

Patient‐reported outcomes after cryoballoon ablation are equivalent between moderate sedation and general anesthesia

Wasserlauf

Kaplan

Walega

et al. 2020

Cardiovasc electrophysiol

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Introduction Moderate sedation (MS) during cryoballoon ablation (CBA) avoids risks of general anesthesia (GA) and improves electrophysiology (EP) lab throughput. However, one barrier to the use of MS is the potential for patient discomfort. The objective of this study was to compare patient‐reported outcome measures following CBA for paroxysmal atrial fibrillation (pAF) under MS and GA. Methods and Results Consecutive patients undergoing a first CBA for pAF under GA or MS were prospectively enrolled. The sedation method was assigned based on patient and provider preference, and perceived airway risk. The primary outcomes were quality of recovery (measured using a validated 40 question survey; QoR‐40) and likelihood to recommend (LTR) the procedure and sedation method (measured by Likert scale). Secondary outcomes were acute pulmonary vein (PV) isolation rate, procedure, fluoroscopy and ablation times, and complication rates. Forty‐seven GA and 53 MS patients were included. The mean age was 64.9 ± 9.4 years and mean CHA2DS2‐VASc score was 2.0 ± 1.4. QoR‐40 scores were 184.6 ± 16.4 for GA and 187.6 ± 10.2 for MS (P = .28). LTR responses were similar between groups. Mean procedure times were 148.2 ± 56.0 minutes for GA and 129.4 ± 31.4 minutes for MS (P = .038). Fluoroscopy and ablation times were similar between groups. A total of 100% (409/409) of PVs were acutely isolated. One hemopericardium occurred in the MS group requiring pericardiocentesis. Conclusion MS for CBA offers an alternative to GA that is safe and well‐tolerated by patients with comparable success rates and improved EP lab throughput.

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“…In their study, a moderate sedation reduced laboratory time compared to GA (280.4 ± 54.1 min vs 245.5 ± 54.7 min, P<0.001) (ref. 7 ). In a study with remote magnetic ablation, Bun et al concluded that GA is not superior to local anesthesia (237 ± 50 min vs. 240 ± 61 min, P=0.84) (ref.…”

Section: Discussionmentioning

confidence: 99%

General anesthesia or conscious sedation in paroxysmal atrial fibrillation catheter ablation

Moravec¹,

Škála²,

Klementová³

et al. 2021

BIOMED PAP

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Background. Catheter ablation of paroxysmal atrial fibrillation (AF) can be performed under general anesthesia or conscious sedation. The influence of type of anesthesiology care on procedural characteristics and ablation outcome in patients in whom intracardiac echocardiography (ICE) and elimination of adenosine-mediated dormant conduction (DC) is used is not entirely known. Methods. 150 patients with paroxysmal AF were randomized to point-by-point radiofrequency catheter isolation of pulmonary veins (PVI) under general anesthesia (n=77) or conscious sedation (n=73). Adenosine-mediated dormant conduction was eliminated in all patients. Antiarrhythmic medication was discontinued after PVI. During twelve months of follow-up, all patients underwent four times 7-day ECG monitorings. Results. There was no difference between groups in AF recurrence (28.6% vs. 31.5%, P=0.695). Patients in conscious sedation had longer procedure times (160 ± 32.1 vs. 132 ± 31.5 min., P<0.001), longer RF energy application times (40 ± 15 vs. 29 ± 11 min. P<0.001) and longer fluoroscopy times (6.2 min ± 5.3 vs. 4.3 min ± 2.2, P<0.001) with similar complication rates. Conclusion. Conscious sedation is not inferior to general anesthesia in regard to arrhythmia recurrence or complication rates of catheter ablation of paroxysmal atrial fibrillation. However, it is associated with longer procedure times, longer time of radiofrequency energy application and longer fluoroscopy times.

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Moderate Sedation Reduces Lab Time Compared to General Anesthesia during Cryoballoon Ablation for AF Without Compromising Safety or Long‐Term Efficacy

Abstract: Compared to GA, MS during CBA for pAF was independently associated with shorter total EP laboratory time without compromising FFAF or complication rates.

Cited by 31 publications

References 19 publications

Safety of conscious sedation in electroanatomical mapping procedures and cryoballoon pulmonary vein isolation

Safety of conscious sedation in electroanatomical mapping procedures and cryoballoon pulmonary vein isolation

Patient‐reported outcomes after cryoballoon ablation are equivalent between moderate sedation and general anesthesia

General anesthesia or conscious sedation in paroxysmal atrial fibrillation catheter ablation

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