Abstract 220 Comparison of periprocedural analgosedation in patients undergoing pulsed field ablation or cryoballoon ablation for atrial fibrillation

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02302-4
Comparison of periprocedural analgosedation in patients undergoing pulsed field ablation or cryoballoon ablation for atrial fibrillation
R. Wahedi¹, S. Willems¹, M. Jularic¹, J. Hartmann¹, O. Anwar¹, J. Dickow¹, T. Harloff¹, M. A. Gunawardene¹
¹Kardiologie, Asklepios Klinik St. Georg, Hamburg;
Background: Pulsed field ablation (PFA) represents a novel, non-thermal energy modality that can be applied for pulmonary vein isolation (PVI) in atrial fibrillation (AF). Data regarding sedation, analgesia requirements and haemodynamic stability compared to other established single-shot modalities such as cryoballoon (CB) ablation are scarce. Aim: The aim of this trial was to compare PVI using PFA versus CB with regards to sedation including analgesia requirements, as well as haemodynamic stability and sedation-associated complications. Methods: We conducted a single-centre retrospective study comparing patients with paroxysmal, persistent, and long-standing persistent AF undergoing PVI with either PFA or CB. Study endpoints were the requirements of propofol, midazolam and sufentanyl, assessment of haemodynamic stability measured as mean decreases in oxygen saturation and systolic blood pressure and sedation-associated complications such as aspiration and/or pneumonia. Secondary endpoints were procedure time and duration of hospitalisation. Results: A total of 100 PVI patients were included {PFA n=50, CB n=50, PFA mean age 67 ± 10.7 years years, 64% male, 72 % paroxysmal AF, mean CHA₂-DS₂-VASc Score 2.2 ± 1.5, mean BMI 26.2 ± 3.5 and CB mean age 65 ± 10.6 years, 58% male, paroxysmal AF 58%, mean CHA₂-DS₂-VASc Score 2.4 ± 1.3, mean BMI 29.4 ± 8.6 (p=0.017)}. Requirement of propofol, midazolam and sufentanyl was significantly higher in the PFA group compared to CB {Propofol 0.14 mg/kg/min ± 0.04 in PFA, 0.11 mg/kg/min ± 0.033 in CB (p<0.0001), midazolam 0.00086 mg/kg/min ± 0.00040 in PFA, 0.00059 mg/kg/min ± 0.0003 in CB (p=0.0002) and sufentanyl 0.0013 µg ± 0.0007 in PFA, 0.00074 µg ± 0.0003 in CB (p<0.0001)}. PFA was also associated with larger decreases in oxygen saturation {PFA 4.9% ± 5.3, CB 3.5% ± 2.6 (p=0.0967)} and systolic blood pressure {PFA 54.5 mmHg ± 20.9, CB 50.2 mmHg ± 18.6 (p=0.214)}, however no bag mask ventilation or vasopressor support was needed in both groups. Sedation-associated complications did not differ significantly between both groups (PFA n=1/50 mild aspiration pneumonia, CB n=0/50, p=0.921). Regarding secondary outcomes, PFA was associated with significantly shorter procedure times {PFA 75 min ± 31, CB 88.2 min ± 30.9 (p=0.03)} and non-significantly shorter duration of hospitalisation (PFA 1.7 d ± 0.9, CB 1.9 d ± 1.3 (p=0.2858)}. Conclusions: Pulsed field ablation is associated with higher sedation and analgesia requirements and a signal for larger decreases in oxygen saturation and blood pressure compared to cryoballoon ablation, however, the safety of analgosedation does not differ significantly to cryoballoon ablation.
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