Catheter Stability With Bispectral Index-Guided Deep Sedation Supported by Heated Humidified High-Flow Nasal Oxygen During Variable-Loop Catheter Pulsed Field Ablation

Q: What are the key findings of this study?

THRIVE-supported BIS-guided deep sedation was associated with significantly smaller catheter displacement compared to standard deep sedation (adjusted mean difference -3.62 mm) during variable-loop pulsed field ablation.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=111). Intervention: THRIVE-based deep sedation vs. Standard deep sedation. Primary outcome: Patient-level mean catheter displacement across all 4 pulmonary veins (Adjusted mean difference -3.62 mm, 95% CI -4.56, -2.68, p=<0.001).

Q: What does this research mean for the field?

Bispectral index-guided deep sedation supported by transnasal humidified rapid-insufflation ventilatory exchange maintains catheter stability during variable-loop catheter pulsed field ablation. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess catheter stability during variable-loop catheter pulsed field ablation under bispectral index-guided deep sedation supported by transnasal humidified rapid-insufflation ventilatory exchange.

Hirotsugu Sato; Shiro Nakahara; Reiko Fukuda-Shimada; Yuta Kimura; Keisuke Nakabayashi; Yuji Itabashi; Isao Taguchi

doi:10.1253/circrep.cr-26-0274

September 17, 2026Circulation ReportsOpen Access

Catheter Stability With Bispectral Index-Guided Deep Sedation Supported by Heated Humidified High-Flow Nasal Oxygen During Variable-Loop Catheter Pulsed Field Ablation

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Key result

THRIVE-supported BIS-guided deep sedation is linked to ~3.6 mm less catheter displacement during pulsed field ablation.

Adjusted mean difference -3.62 mm
95% CI -4.56, -2.68
P<0.001
n=111

Why the study?

Pulsed field ablation can provoke muscle contraction, cough, and body movement, potentially compromising catheter stability, necessitating evaluation of BIS-guided deep sedation with THRIVE support.

Does THRIVE-based deep sedation improve catheter stability during variable-loop catheter PFA in patients with atrial fibrillation compared to standard deep sedation or general anesthesia?

Key Points

To assess catheter stability during variable-loop catheter pulsed field ablation under bispectral index-guided deep sedation supported by transnasal humidified rapid-insufflation ventilatory exchange.
Analyzed 111 patients undergoing variable-loop catheter pulsed field ablation categorized into 3 sedation strategies: standard deep sedation (n=20), THRIVE-based deep sedation (n=53), and general anesthesia (n=38).
Evaluated patient-level mean catheter displacement across pulmonary veins, tissue proximity indicator positivity, procedural durations, and procedural interruptions.
Median overall catheter displacement was lowest with THRIVE (2.40 mm) compared with general anesthesia (3.30 mm, P=0.007) and standard deep sedation (6.06 mm, P<0.001); multivariable regression showed THRIVE reduced displacement versus standard deep sedation (adjusted mean difference -3.62 mm; 95% CI -4.56, -2.68; P<0.001).
Motion-related procedural interruptions occurred in 30.0% (6/20) of standard deep sedation patients, 1.9% (1/53) of THRIVE patients, and 0.0% (0/38) of general anesthesia patients (P<0.001).
Hypoxemic events were recorded in 35.0% (7/20) under standard deep sedation, 1.9% (1/53) under THRIVE, and 0.0% (0/38) under general anesthesia (P<0.001).

Study Design

Type

Cohort (n=111)

Multicenter

No

Structured PICO

Does THRIVE-based deep sedation improve catheter stability during variable-loop catheter PFA in patients with atrial fibrillation compared to standard deep sedation or general anesthesia?

P

Population

111 patients with atrial fibrillation undergoing variable-loop catheter pulsed field ablation, evaluated retrospectively to compare catheter stability under different sedation strategies.

E

Exposure

Bispectral index (BIS)-guided deep sedation supported by transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) at 70 L/min with FiO2 1.0

C

Comparator

Standard deep sedation (oxygen via simple face mask) and anesthesiologist-managed general anesthesia (GA)

O

Outcome

Patient-level mean catheter displacement across all 4 pulmonary veins (PVs) measured by CARTO 3 electroanatomical mapping systemsurrogate

Main Result

Mean Difference: -3.62 (95% CI -4.56–-2.68)

Absolute Event Rate: 2.4% vs 6.06%

p-value: p=<0.001

THRIVE-supported BIS-guided deep sedation significantly improves catheter stability and procedural conditions during variable-loop PFA compared to standard deep sedation, offering a viable alternative to general anesthesia.

Limitations

Retrospective, single-center, non-randomized study with partly era-dependent sedation allocation, introducing potential selection, temporal, learning-curve, and workflow biases.
Modest sample size, particularly in the standard deep sedation group, and not powered for formal safety comparisons.
CARTO-derived catheter displacement is a procedural surrogate reflecting respiratory-phase-related motion, not a direct measure of application-level stability, lesion durability, or clinical outcome.
Retrospective design
Non-randomized treatment allocation
Limited subset of patients for CO2 analysis

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Implication

May reduce catheter displacement in PFA; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

Background: Pulsed field ablation (PFA) can provoke muscle contraction, cough, and body movement, potentially compromising catheter stability. We evaluated bispectral index (BIS)-guided transnasal humidified rapid-insufflation ventilatory exchange (THRIVE)-based deep sedation during variable-loop catheter PFA.

Discussion

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Cite This Study

Sato et al. (2026) conducted a cohort in Atrial fibrillation (n=111). THRIVE-based deep sedation vs. Standard deep sedation was evaluated on Patient-level mean catheter displacement across all 4 pulmonary veins (Adjusted mean difference -3.62 mm, 95% CI -4.56, -2.68, p=<0.001). THRIVE-supported BIS-guided deep sedation was associated with significantly smaller catheter displacement compared to standard deep sedation (adjusted mean difference -3.62 mm) during variable-loop pulsed field ablation.

synapsesocial.com/papers/6ac4785f911aa2f2ff4dd46e https://doi.org/10.1253/circrep.cr-26-0274

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Catheter Stability With Bispectral Index-Guided Deep Sedation Supported by Heated Humidified High-Flow Nasal Oxygen During Variable-Loop Catheter Pulsed Field Ablation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Catheter Stability With Bispectral Index-Guided Deep Sedation Supported by Heated Humidified High-Flow Nasal Oxygen During Variable-Loop Catheter Pulsed Field Ablation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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