Key result
Dexmedetomidine- and flurbiprofen-based sedation linked to higher target sedation rates vs midazolam in pulsed field ablation.
Why the study?
Deep sedation is increasingly used during pulsed field ablation for AF, but the optimal electrophysiologist-led sedation regimen remains unclear.
Do electrophysiologist-led deep sedation protocols using flurbiprofen axetil + midazolam + fentanyl or dexmedetomidine + fentanyl improve the achievement of target sedation level at ablation initiation compared to midazolam + fentanyl in patients undergoing pulsed field ablation for atrial fibrillation?
Observational (n=166)
No
Do electrophysiologist-led deep sedation protocols using flurbiprofen axetil + midazolam + fentanyl or dexmedetomidine + fentanyl improve the achievement of target sedation level at ablation initiation compared to midazolam + fentanyl in patients undergoing pulsed field ablation for atrial fibrillation?
During pulsed field ablation for atrial fibrillation, electrophysiologist-led deep sedation protocols incorporating flurbiprofen axetil or dexmedetomidine achieve target sedation levels more frequently and with greater operator satisfaction than midazolam plus fentanyl alone, though dexmedetomidine increases the risk of intraoperative hypotension.
May enhance target sedation in PFA; hypothesis-generating and requires randomized trials before adoption.
BACKGROUND: Deep sedation (DS) is increasingly utilized during pulsed field ablation (PFA) for atrial fibrillation (AF), but the optimal electrophysiologist-led sedation regimen remains unclear. OBJECTIVE: To compare sedative effectiveness and safety of three electrophysiologist-led DS protocols. METHODS: In this prospective, single-center study, AF patients undergoing focal-form PFA received (1) midazolam + fentanyl (Midazolam group), (2) flurbiprofen axetil + midazolam + fentanyl (Flurbiprofen group), or (3) dexmedetomidine + fentanyl (Dexmedetomidine group). The primary endpoint was the achievement of the target sedation level at ablation initiation (Ramsay Sedation Score ≥3). Secondary endpoints included intraoperative pain, sedation difficulty, operator satisfaction, and sedation-related adverse events. RESULTS: 166 patients (mean age, 62.2 ± 10.8 years; 62.7% male; 48.2% with paroxysmal AF) were enrolled, with 53, 67, and 46 patients included in the Midazolam, Flurbiprofen, and Dexmedetomidine groups, respectively. The primary outcome occurred more frequently in the Flurbiprofen (73.1%) and Dexmedetomidine (82.6%) groups compared to Midazolam (47.2%) (overall p < 0.001); Flurbiprofen and Dexmedetomidine group did not differ significantly. Intraoperative pain scores were lowest with Dexmedetomidine (overall p < 0.001). Both Flurbiprofen and Dexmedetomidine groups showed lower sedation difficulty and higher operator satisfaction than the Midazolam group (both overall p < 0.001). Dexmedetomidine was associated with more intraoperative hypotension (overall p = 0.047). CONCLUSION: Electrophysiologist-led DS protocols with Flurbiprofen and Dexmedetomidine were associated with higher target sedation attainment than the specific low-dose Midazolam regimen during PFA, but Dexmedetomidine is linked to higher hypotension rates, warranting caution.
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Zhao et al. (2026) conducted an observational in Atrial fibrillation undergoing focal-form pulsed field ablation (n=166). Flurbiprofen axetil + midazolam + fentanyl or dexmedetomidine + fentanyl deep sedation protocols vs. Midazolam + fentanyl (Midazolam group) was evaluated on Achievement of target sedation level at ablation initiation (Ramsay Sedation Score >=3) (p=< 0.001). Flurbiprofen (73.1%) and dexmedetomidine (82.6%) deep sedation protocols achieved higher target sedation during AF pulsed field ablation than midazolam (47.2%; p<0.001).
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