Abstract
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.
Highlights
The number of complex electrophysiological procedures has increased over the last decades [1, 2]
For treatment of atrial arrhythmia, different techniques dependent on the type of arrhythmia can be applied: pulmonary vein isolation (PVI) to treat atrial fibrillation may be achieved either by pointby-point radiofrequency ablation guided by 3D-mapping systems or by single-shot anatomical ablation devices, such
125 patients were included in the analysis. 67 patients underwent cryoballoon pulmonary vein isolation (PVI) for atrial fibrillation and 58 patients had an atrial electroanatomic mapping (EAM) and radiofrequency (RF) ablation procedure
Summary
The number of complex electrophysiological procedures has increased over the last decades [1, 2]. For treatment of atrial arrhythmia, different techniques dependent on the type of arrhythmia can be applied: pulmonary vein isolation (PVI) to treat atrial fibrillation may be achieved either by pointby-point radiofrequency ablation guided by 3D-mapping systems or by single-shot anatomical ablation devices, such. Heart and Vessels (2021) 36:561–567 oximetry, non-invasive or invasive blood pressure measurements and continuous electrocardiographic monitoring [4]. Continuous, transcutaneous carbondioxide measurement may provide more detailed, real-time information on the ventilatory status of the patient without the necessity to draw and analyze blood samples. At our center, depending on the sedation requirements of different techniques, we apply differential sedation schemes for cryoballoon procedures and 3D-mapping procedures. There is a gap of evidence regarding the safety of deep conscious sedation required for 3D electroanatomical mapping in comparison to moderate conscious sedation for cryoballoon procedures
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