The Practice of Deep Sedation in Electrophysiology and Cardiac Pacing Laboratories: Results of an Italian Survey Promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing).

Michele Accogli,Pasquale Notarstefano,Andrea Angeletti,Federico Guerra,Roberto De Ponti,Matteo Bertini,Maurizio Landolina,Matteo Ziacchi,Renato Pietro Ricci,Giovanni Battista Forleo,Carlo Lavalle,Giuseppe Boriani,Gabriele Zanotto,Pietro Palmisano,Antonio D’Onofrio,Giovanni Bisignani

doi:10.3390/jcm10215035

Abstract

The aim of this survey, which was open to all Italian cardiologists involved in arrhythmia, was to assess common practice regarding sedation and analgesia in interventional electrophysiology procedures in Italy. The survey consisted of 28 questions regarding the approach to sedation used for elective direct-current cardioversion (DCC), subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation, atrial fibrillation (AF) ablation, ventricular tachycardia (VT) ablation, and transvenous lead extraction procedures. A total of 105 cardiologists from 92 Italian centres took part in the survey. The rate of centres where DCC, S-ICD implantation, AF ablation, VT ablation and lead extraction procedures were performed without anaesthesiologic assistance was 60.9%, 23.6%, 51.2%, 37.3%, and 66.7%, respectively. When these procedures were performed without anaesthesiologic assistance, the drugs (in addition to local anaesthetics) commonly administered were benzodiazepines (from 64.3% to 79.6%), opioids (from 74.4% to 88.1%), and general anaesthetics (from 7.1% to 30.4%). Twenty-three (21.9%) of the 105 cardiologists declared that they routinely administered propofol, without the supervision of an anaesthesiologist, in at least one of the above-mentioned procedures. In current Italian clinical practice, there is a lack of uniformity in the sedation/analgesia approach used in interventional electrophysiology procedures.

Highlights

The number of complex electrophysiological procedures has increased over recent decades
The questionnaire could be completed by more than one cardiologist from the same centre and was composed of 28 questions: 13 on the characteristics of the hospital (i.e., number of beds; availability of a surgery, anaesthesiology and intensive care unit (ICU); types and annual volume of interventional electrophysiology procedures); 15 concerned the approach to sedation used for elective direct-current cardioversion (DCC), subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation, atrial fibrillation (AF) ablation, ventricular tachycardia (VT) ablation, and transvenous lead extraction procedures
In 10 centres, more than one cardiologist participated in the survey

Summary

Introduction

The number of complex electrophysiological procedures has increased over recent decades. These procedures can be painful and immobility of the patient is necessary for the success of the procedure. For this reason, deep sedation or general anaesthesia are frequently used. Deep sedation or general anaesthesia are frequently used While the former can be achieved through a proceduralist-directed nurseadministered (PDNA) approach, the latter requires anesthesiologic support. The PDNA approach has the advantage of eliminating the need for anaesthesiologists and can reduce pre-procedure time. Safety warnings on deep sedation are reported in the literature, regarding the need to switch to general anaesthesia or to undertake urgent airway interventions [1,2]

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Discussion

Conclusion