Current status and associated factors of intraoperative pain during radiofrequency catheter ablation for atrial fibrillation under conscious sedation: single-center experience

OBJECTIVES: This study was performed to evaluate the current status and to analyze the associated factors of intraoperative pain experience during radiofrequency ablation of atrial fibrillation (AF) with conscious sedation and analgesia. METHODS: This cross-sectional observational study employed convenience sampling of AF patients underwent their first radiofrequency ablation. General information questionnaire, intraoperative status sheet, Wong-Baker faces pain rating scale, hospital anxiety and depression scale, and the Connor-Davidson Resilience Scale were employed for data collection and analysis. RESULTS: A total of 428 patients (mean age 66.5 ± 9.6years; 59.8% male) were enrolled in this study. At ablation start, 62.9% of patients had moderate pain. When ablating specific regions, moderate pain and severe pain was encountered in 76.2% and 11.7% patients, respectively. Female patients had higher pain score than male patients at the followed 3 time-points: ablation start, ablating specific regions, and sheaths removal (z =-2.923, -4.349, -2.385, respectively, all P < 0.05). A negative correlation between the interoperative pain scales and the psychological resilience scales was confirmed at the time-point of before sedation, during ablation, ablating specific regions, and sheaths removal (r=-0.161, -0.464, -0.773, -0.352, respectively, all P < 0.05). Multivariable logistic regression analysis revealed that the strength and resilience dimensions of psychological resilience were significant protective factors against pain during radiofrequency ablation, with low levels of strength and tenacity associated with 2.32-fold and 2.17-fold increased risks of moderate pain, respectively, while optimism and clinical factors showed no significant effects. CONCLUSION: Most of AF patients undergoing radiofrequency ablation with conscious sedation and analgesia experienced significant intraoperative pain experience, particularly when specific cardiac regions were ablated. Enhancing psychological resilience before the procedure may help reduce intraoperative pain scores. TRIAL REGISTRATION: This trial is registered on Mar 17th, 2022, in the Chinese Clinical Trial Registry (ChiCTR2200057810).