Key result
Continuous dexmedetomidine and remifentanil cuts movement disrupting 3D mapping ~54% versus midazolam and fentanyl.
Why the study?
The efficacy of dexmedetomidine for radiofrequency catheter ablation of atrial fibrillation had not been well established.
Does continuous infusion of dexmedetomidine and remifentanil reduce patient movement resulting in 3D mapping system discordance in patients undergoing radiofrequency catheter ablation for atrial fibrillation?
RCT (n=240)
Open-label
Simple randomization
No
Does continuous infusion of dexmedetomidine and remifentanil reduce patient movement resulting in 3D mapping system discordance in patients undergoing radiofrequency catheter ablation for atrial fibrillation?
Absolute Event Rate: 18.2% vs 39.5%
p-value: p=<0.001
Continuous infusion of dexmedetomidine and remifentanil provides more stable sedation with less patient movement during AF ablation compared to midazolam and fentanyl, but is associated with more frequent hypotension and bradycardia.
Supports dexmedetomidine-remifentanil for stable AF ablation sedation; extends comparative data while cautioning on hypotension and bradycardia.
Background and objectives The efficacy of dexmedetomidine for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has not been well established. We evaluated the efficacy and safety of sedation using dexmedetomidine with remifentanil compared to conventional sedative agents during RFCA for AF. Subjects and methods A total of 240 patients undergoing RFCA for AF were randomized to either the dexmedetomidine (DEX) group (continuous infusion of dexmedetomidine and remifentanil) or the midazolam (MID) group (intermittent injections of midazolam and fentanyl) according to sedative agents. Non-invasive positive pressure ventilation was applied to all patients during the procedure. The primary outcome was patient movement during the procedure resulting in a 3D mapping system discordance, and the secondary outcome was adverse events including respiratory or hemodynamic compromise. Results During AF ablation, the incidence of the primary outcome was significantly reduced for the DEX group (18.2% vs. 39.5% in the DEX and the MID groups, respectively, p < 0.001). The frequency of a desaturation event (oxygen saturation < 90%) did not significantly differ between the two groups (6.6% vs. 1.7%, p = 0.056). However, the incidences of hypotension not owing to cardiac tamponade (systolic blood pressure < 80 mmHg, 19.8% vs. 8.4%, p = 0.011) and bradycardia (HR < 50 beats/min: 39.7% vs. 21.8%, p = 0.003) were higher in the DEX group. All efficacy and safety results were consistent within the predefined subgroups. Conclusion The combined use of dexmedetomidine and remifentanil provides higher stability sedation during AF ablation, but can lead to more frequent hemodynamic compromise compared to midazolam and fentanyl.
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Choi et al. (2019) conducted an RCT in Atrial fibrillation (n=240). Dexmedetomidine and remifentanil vs. Midazolam and fentanyl was evaluated on Patient movement resulting in 3D mapping system discordance and transient procedure interruption (p=<0.001). Continuous infusion of dexmedetomidine and remifentanil significantly reduced patient movement resulting in 3D mapping system discordance compared to midazolam and fentanyl (18.2% vs. 39.5%, p<0.001).
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