Key result
Inspiration-induced negative left atrial pressure during atrial fibrillation ablation under deep sedation was associated with a higher rate of air embolism compared to no INLAP (3.0% vs 0.0%).
Why the study?
Deep sedation during AF ablation may cause inspiration-induced negative left atrial pressure associated with deep inspiration, which could lead to periprocedural complications.
Is inspiration-induced negative left atrial pressure (INLAP) during AF ablation under deep sedation associated with periprocedural complications?
Observational (n=381)
Is inspiration-induced negative left atrial pressure (INLAP) during AF ablation under deep sedation associated with periprocedural complications?
Inspiration-induced negative left atrial pressure is not rare during AF ablation under deep sedation and is associated with an increased risk of air embolism.
INLAP during sedated AF ablation was associated with air embolism; leaves open whether pressure monitoring or sedation adjustments reduce risk.
BACKGROUND: Atrial fibrillation (AF) ablation is performed under deep sedation, which may cause inspiration-induced negative left atrial pressure (INLAP) associated with deep inspiration. INLAP could be the cause of periprocedural complications. METHODS: We retrospectively enrolled 381 patients with AF (mean age, 63.9 ± 10.8 years; 76 women; 216 cases of paroxysmal AF) who underwent CA under deep sedation using an adaptive servo ventilator (ASV). Patients whose LAP was not obtained were excluded. INLAP was defined as <0 mmHg of mean LAP during inspiration immediately after the transseptal puncture. The primary and secondary endpoints were the presence of INLAP and the incidence of periprocedural complications. RESULTS: -Vasc scores (2.3 ± 1.5 vs. 2.1 ± 1.6) and 3% oxygen desaturation indexes (median 18.6 (interquartile range 11.2-31.1) vs. 15.7 (8.1-25.3)), and higher prevalence of diabetes mellitus (23.3 vs. 13.3%) than patients without INLAP. Air embolism occurred in four patients with INLAP (3.0 vs. 0.0%). CONCLUSION: INLAP is not rare in patients undergoing CA for AF under deep sedation with ASV. Much attention should be paid to the possibility of air embolism in patients with INLAP.
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Ikoma et al. (2023) conducted an observational in Atrial fibrillation (n=381). Inspiration-induced negative left atrial pressure (INLAP) vs. No INLAP was evaluated on Presence of INLAP and the incidence of periprocedural complications. Inspiration-induced negative left atrial pressure during atrial fibrillation ablation under deep sedation was associated with a higher rate of air embolism compared to no INLAP (3.0% vs 0.0%).
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