Operator-directed sedation for AF ablation using a variable loop circular PFA catheter: an institutional protocol

Background General anaesthesia is generally the standard sedation protocol used during pulsed field ablation (PFA) of atrial fibrillation (AF) however monitored anaesthesia with deep sedation is becoming an increasingly used approach and could represent a feasible alternative to achieve the same goal with few drawbacks. Purpose We aimed to evaluate the applicability ad feasibility of a deep sedation protocol during AF ablation with a variable loop circular PFA catheter by assessing patient and operator reported outcomes. Methods At the operator’s discretion, a selected number of patients, after being adequately informed, underwent AF ablation with a variable loop circular PFA catheter using an analgosedation protocol consisting of continuous infusion of dexmedetomidine, bolus followed by continuous infusion of lidocaine, boluses of midazolam and fentanyl citrate. At the end of the procedure Likert Scale Questionnaires and Visual-Analog Scales were used to assess the patients’ and operators’ satisfaction with intraoperative analgesia and sedation. Results the study population consisted of 20 patients [male gender 12, mean age 61 ± 11] that underwent paroxysmal [90%] and persistent [10%] AF ablation with a variable loop circular PFA catheter. The primary operator reported being satisfied or very satisfied with the sedation protocol in all the procedures performed with a high likelihood of choosing the same approach in the case of executing the same intervention with this PFA catheter. In 95% of the cases patients did not recall experiencing pain during the procedure, 90% did not remember being anxious during the intervention with 95% of patients reporting no discomfort. After the procedure patient satisfaction was ranked very positively [98 ± 6] as well as pain level [2 ± 4], anxiety [3 ± 10] and discomfort [1 ± 2]. The mean electrophysiology (EP) lab occupation was 126 ± 43 minutes. No complications were reported. Conclusions Employing a deep sedation operator-guided protocol represents a feasible, effective and safe alternative to general anaesthesia in AF ablation procedures with a variable loop circular PFA catheter, showing positive results in terms of operator and patient satisfaction, as well as safety and EP lab occupation time.