Pulsed-field ablation using a penta-spline catheter in pulmonar vein isolation. Comparative analysis of general anaesthesia and deep sedation

Background Pulsed field ablation (PFA) is a novel non-thermal ablation modality introduced into the field of cardiac arrhythmias. Pulmonar Vein Isolation (PVI) is one of the most common interventions. Access to general anaesthesia (GA) can be a limitation for these ablations. Purpose Deep sedation (DS) can be similar to GA in terms of effectiveness (atrial arrhythmia-free survival) and safety (complications). Methods Patients referred for pulmonary vein isolation were included consecutively. PVI was performed using a PFA penta-spline catheter. Patients underwent ablation under GA or DS depending on availability. GA was conducted by experienced cardiac anaesthesiologists. DS was managed by trained staff of the electrophysiology laboratories and initiated by a bolus of fentanyl, midazolam and propofol followed by a continuous propofol infusion. Results 244 patients were analyzed (202 with DS and 42 with GA). The baseline characteristics were very similar (figure 1). The GA group had a higher percentage of women and more frequently underwent ablation in atrial flutter. Effectiveness. At one year, 81.7% remain free of atrial arrhythmias under DS and 81% under GA (log rank 0,855). Figure 2. The arrhythmia-free rate at one year was very similar when patients with paroxysmal and persistent atrial fibrillation were analyzed. Complications. The complication profile was very similar. The DS group experienced a single embolic event and two minor vascular complications for only one minor vascular complication in GA group. Conclusions DS is an effective and safe alternative to GA for PVI using a PFA penta-spline catheter. DS may be an alternative in cases of limited access to GA.Baseline characteristics.One-year free survival arrhythmias.