Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Predictors of sedation associated complications in patients undergoing left atrial Ablation under Deep sedation with propofol
L. V. Förschner1, N. Harfoush1, M. Thoma1, F. Bourier2, T. Reents2, S. Lengauer1, M. Telishevska1, C. Lennerz3, M.-A. Popa1, S. Maurer1, H. Krafft2, G. Heßling2, I. Deisenhofer2, M. Kottmaier2, für die Studiengruppe: MARS
1Elektrophysiologie, Deutsches Herzzentrum München, München; 2Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, München; 3Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München;

Background:

Catheter ablation for atrial fibrillation (AF) or left atrial tachycardia (AT) is a well-established treatment option. To avoid body movement and suppress pain during the procedure sedative agents are commonly used. Aim of this study was to investigate safety of propofol for deep sedation administered by EP staff (EP nurse and electrophysiologist with intensive care training) in patients undergoing left atrial ablation procedures.

Methods:
We included 3211 consecutive patients (61% male, mean age 65.8 years +/-11.6 years, mean CHADSVASC score 2.6 +/- 1.7) that underwent left atrial ablation for paroxysmal AF (n=1191, 37.1%), persistent AF (n=1132, 35.3%) or left atrial AT (n=886, 27.6%). Deep sedation was initiated with midazolam and continuous infusion of 1% propofol by EP staff (EP nurses supervised by electrophysiologists with intensive care training).  Fentanyl was administered to control discomfort or pain. The airway was maintained patent using an oropharyngeal Guedel airway tube and continuous oxygen therapy at 2-4 l/min. Endotracheal Intubation (eIT) or non-invasive ventilation (NIV) was considered in case of respiratory depression with a permanent oxygen saturation drop below 85%, pH< 7,25 or retention of CO2. Patients with and without eIT or NIV where compared in terms of baseline and procedural characteristics.

Results:

Mean procedural duration was 133.7min +/- 52.7min. Mean Propofol dose per kg was 33.7 +/- 16.7mg, mean Midazolam dose was 3mg +/- 11.1mg, mean Fentanyl dose was 0.16mg+/- 2.2mg. One patient (0.03%) needed eIT, n= 47 (1.5%) patients needed NIV. Due to hypotension n=396 patients received noradrenaline, mean oxygen saturation drop was 4.5% +/- 27.5. Patients needing eIT or NIV had significantly longer procedure durations, a higher BMI and CHA2DS2-VASC Score, were significantly older, had a lower GFR, suffered more often from diabetes mellitus and had a lower baseline oxygen saturation. The only predictor for eIT or NIV in the multivariat analysis was a higher BMI (>30.1 +/- 9.0kg/m2).

Conclusion:
Propofol administered by EP staff (EP nurses supervised by an electrophysiologist with intensive care training) for deep sedation in patients undergoing left atrial ablation is safe with a low incidence of intubation or NIV.

https://dgk.org/kongress_programme/jt2021/aP1576.html