Simplified propofol-based deep sedation by electrophysiologists: Safe and versatile for pulsed field and thermal ablation

Background Pulsed Field Ablation (PFA) induces substantial procedural pain and typically requires deep sedation (DS) or general anesthesia (GA). However, limited anesthesia resources constrain broad PFA adoption. Objective We evaluated a simplified propofol-based DS protocol (s-DS) for its safety, feasibility and adaptability across various ablation modalities. Methods Between May 2023 and June 2025, 497 consecutive patients underwent ablation under s-DS regimen (propofol infusion and low dose fentanyl only) by the EP-Lab. staff. Procedures included PFA (n=403) and thermal ablation (n = 94) across diverse arrhythmia types. Sedation parameters, hemodynamics, and recovery metrics were prospectively recorded. The study was structured in two phases: Implementation phase (Phase-1, n=144) and Routine adoption (Phase-2, n=353). "Time-to-ward" (TTW) served as a surrogate of team proficiency and workflow efficiency. Results S-DS was feasible and safe. Urgent conversion to GA occurred in one patient (0.2%) and transient mask ventilation was required in 1.8%. PFA required higher fentanyl doses (P < 0.001), had greater mean arterial blood pressure reductions (P = 0.004) and longer TTW´s (P < 0.001) than thermal ablation, while oxygen saturation and respiratory support were comparable. TTW significantly declined with operator and nursing experience (P < 0.001). No major adverse events, airway complications or late respiratory failures occurred. Conclusion S-DS by EP-Lab. staff enabled safe, versatile, effective, and pain-free ablations across all energy sources and arrhythmia types. S-DS offered resource-efficient workflow with short TTW and reduced the need for prolonged post-procedure observation.