Controlled Deep Sedation Protocol With Bispectral Index Monitoring System (Bis) and Continuos Propofol Infusion: A New Sedative Strategy for Pulsed–field Ablation of Atrial Fibrillation

Aims A standardized sedation protocol for pulsed–field ablation (PFA) of atrial fibrillation (AF) through irreversible cellular electroporation has not been well established. We report our experience of a protocol for deep sedation with propofol maintaining spontaneous respiration during the PFA of AF. Bispectral index Monitoring System (BIS) is a technologies used to monitor depth of anesthesia and to maintain a targeted sedation range . Methods and results All consecutive patients undergoing PFA for AF at our center were included. Our sedation protocol involves the intravenous administration of fentanyl (1 mcg/kg) and midazolam (2 mg) at low doses before local anesthesia with lidocaine. A propofol infusion (1 mg/kg/h) was injected about 5 minutes before the first PFA delivery and suspended at the end of the procedure. We enrolled 52 patients (age = 54 +– 9 years, 72,6 % males, body mass index = 26.7+– 5 kg/m2, fluoroscopy time = 21[15–30] min, skin–to–skin time = 70 [60–100] min and PFA LA dwell time = 25[22–28] min). By the end of the procedure, PVI had been achieved in all patients by means of PFA alone. The mean time under sedation was 48.4 –+ 6 min, with 8 (4%) patients being sedated for more than 1 hour. A satisfactory Ramsey Sedation Scale level during propofol infusion was achieved in all patients except one (84.1% of the patients with rank 3; 15.9 % with rank 2). In all procedures, the satisfaction level was found to be acceptable by both the patient and the primary operator (Score = 0 in 99.4% of cases). All patients reported none or mild pain. No major procedure or anesthesia–related complications were reported. Conclusion Our standardized anesthesia protocol with the administration of drugs in association with Bispectral Index Monitoring System to maintain a targeted sedation range during pulsed–field ablation of atrial fibrillation was safe and effective, with an optimal degree of patient and operator satisfaction.