Key result
Conscious sedation for balloon-in-basket PFA leads to ~10% escalation to deep sedation.
Why the study?
Pulsed field ablation for pulmonary vein isolation generally requires general anesthesia or deep sedation, and a previous conscious sedation protocol using fentanyl, midazolam, and lidocaine resulted in discomfort requiring escalation to deep sedation and delayed mobilization due to somnolence in some patients.
Observational (n=38)
Answers are grounded in this paper and cite their sources.
Conscious sedation may suffice for most pulsed field ablation cases with escalation readiness; leaves open optimal protocols for prospective trials.
Pulsed field ablation (PFA) has revolutionized pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF) but generally requires general anesthesia or deep sedation.1 We previously demonstrated the feasibility and safety of conscious sedation (CS) for PVI using the balloon-in-basket PFA system (VOLT™, Abbott). Among 38 patients treated with fentanyl, midazolam, and lidocaine (July-December 2025), 10% required escalation to deep sedation due to discomfort and 10% delayed mobilization due to somnolence after 2-hours bedrest.
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Bax et al. (2026) conducted an observational in Atrial fibrillation undergoing pulmonary vein isolation with balloon-in-basket pulsed field ablation (n=38). Conscious sedation with fentanyl, midazolam, and lidocaine (and alfentanil-based conscious sedation protocol) was evaluated on Escalation to deep sedation due to discomfort and delayed mobilization due to somnolence. Conscious sedation with fentanyl, midazolam, and lidocaine for balloon-in-basket PFA resulted in 10% escalation to deep sedation and 10% delayed mobilization among 38 patients.
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