Key result
Mild conscious sedation for PFA requires ~13% conversion to general anesthesia amid suboptimal pain tolerance.
Why the study?
Pulsed field ablation is typically performed under general anaesthesia or deep sedation requiring anaesthetic support, but no study had tested the feasibility of PFA under mild conscious sedation.
Does mild conscious sedation improve procedural feasibility and patient tolerance in patients undergoing pulsed field ablation for atrial fibrillation?
Cohort (n=23)
Open-label
Non-randomized
No
Does mild conscious sedation improve procedural feasibility and patient tolerance in patients undergoing pulsed field ablation for atrial fibrillation?
Pulsed field ablation under mild conscious sedation is feasible but results in suboptimal pain tolerance and requires high sedative doses compared to general anaesthesia.
Mild conscious sedation warrants caution for pulsed field ablation due to suboptimal tolerance; leaves open optimal sedation strategies in prospective trials.
BACKGROUND: Pulsed field ablation (PFA) is a new modality for pulmonary vein isolation (PVI) for atrial fibrillation (AF). PFA is performed under general anaesthetic (GA) or deep sedation with propofol, but this requires anaesthetic support in many countries, restricting use. No study has tested the feasibility of PFA under mild conscious sedation (MCS). METHODS: We prospectively recruited patients undergoing PFA PVI, offered the option of MCS delivered by electrophysiologists, and compared these with patients who opted for GA. MCS comprised intravenous midazolam and fentanyl. All procedures were performed under anaesthetic supervision in case of requirement to convert to GA, which formed the primary outcome. RESULTS: Twenty-three patients were recruited (8 MCS, 15 GA). One patient (1/8 [12.5%]) required conversion from MCS to GA. Total procedural times were similar between groups (MCS 92 ± 12.4 min vs. GA 101 ± 17.3 min; p = 0.199). High mean sedative doses were required in the MCS group (5.12 ± 0.83 mg midazolam and 209 ± 40 mcg fentanyl). Median intraprocedural pain perception by the patient, rated from 0 to 100 was 45 (IQR 22.5-72.5) in the MCS group. Post-procedural groin pain (0 [0-0] vs. 5 [0-35]; p = 0.027) and throat pain (0 [0-0] vs. 10 [5-40]; p = 0.001) were lower in the MCS group. CONCLUSION: PFA under MCS is feasible in selected patients but pain and tolerance may be suboptimal, and high sedative doses are required.
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Calvert et al. (2024) conducted a cohort in Atrial fibrillation (n=23). Mild conscious sedation (MCS) vs. General anaesthesia (GA) was evaluated on Need for conversion to general anaesthesia in the mild conscious sedation arm. Mild conscious sedation for pulsed field ablation was feasible, with 12.5% of patients requiring conversion to general anaesthesia, though high sedative doses were required and pain tolerance was suboptimal.
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