Propofol sedation administered by cardiologists for patients undergoing catheter ablation for ventricular tachycardia

TY - JOUR

T1 - Propofol sedation administered by cardiologists for patients undergoing catheter ablation for ventricular tachycardia

AU - Servatius, Helge

AU - Höfeler, Thormen

AU - Hoffmann, Boris A

AU - Sultan, Arian

AU - Lüker, Jakob

AU - Schäffer, Benjamin

AU - Willems, Stephan

AU - Steven, Daniel

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

PY - 2016/8

Y1 - 2016/8

N2 - AIMS: Propofol sedation has been shown to be safe for atrial fibrillation ablation and internal cardioverter-defibrillator implantation but its use for catheter ablation (CA) of ventricular tachycardia (VT) has yet to be evaluated. Here, we tested the hypothesis that VT ablation can be performed using propofol sedation administered by trained nurses under a cardiologist's supervision.METHODS AND RESULTS: Data of 205 procedures (157 patients, 1.3 procedures/patient) undergoing CA for sustained VT under propofol sedation were analysed. The primary endpoint was change of sedation and/or discontinuation of propofol sedation due to side effects and/or haemodynamic instability. Propofol cessation was necessary in 24 of 205 procedures. These procedures (Group A; n = 24, 11.7%) were compared with those with continued propofol sedation (Group B; n = 181, 88.3%). Propofol sedation was discontinued due to hypotension (n = 22; 10.7%), insufficient oxygenation (n = 1, 0.5%), or hypersalivation (n = 1, 0.5%). Procedures in Group A were significantly longer (210 [180-260] vs. 180 [125-220] min, P = 0.005), had a lower per hour propofol rate (3.0 ± 1.2 vs. 3.8 ± 1.2 mg/kg of body weight/h, P = 0.004), and higher cumulative dose of fentanyl administered (0.15 [0.13-0.25] vs. 0.1 [0.05-0.13] mg, P < 0.001), compared with patients in Group B. Five (2.4%) adverse events occurred.CONCLUSION: Sedation using propofol can be safely performed for VT ablation under the supervision of cardiologists. Close haemodynamic monitoring is required, especially in elderly patients and during lengthy procedures, which carrying a higher risk for systolic blood pressure decline.

AB - AIMS: Propofol sedation has been shown to be safe for atrial fibrillation ablation and internal cardioverter-defibrillator implantation but its use for catheter ablation (CA) of ventricular tachycardia (VT) has yet to be evaluated. Here, we tested the hypothesis that VT ablation can be performed using propofol sedation administered by trained nurses under a cardiologist's supervision.METHODS AND RESULTS: Data of 205 procedures (157 patients, 1.3 procedures/patient) undergoing CA for sustained VT under propofol sedation were analysed. The primary endpoint was change of sedation and/or discontinuation of propofol sedation due to side effects and/or haemodynamic instability. Propofol cessation was necessary in 24 of 205 procedures. These procedures (Group A; n = 24, 11.7%) were compared with those with continued propofol sedation (Group B; n = 181, 88.3%). Propofol sedation was discontinued due to hypotension (n = 22; 10.7%), insufficient oxygenation (n = 1, 0.5%), or hypersalivation (n = 1, 0.5%). Procedures in Group A were significantly longer (210 [180-260] vs. 180 [125-220] min, P = 0.005), had a lower per hour propofol rate (3.0 ± 1.2 vs. 3.8 ± 1.2 mg/kg of body weight/h, P = 0.004), and higher cumulative dose of fentanyl administered (0.15 [0.13-0.25] vs. 0.1 [0.05-0.13] mg, P < 0.001), compared with patients in Group B. Five (2.4%) adverse events occurred.CONCLUSION: Sedation using propofol can be safely performed for VT ablation under the supervision of cardiologists. Close haemodynamic monitoring is required, especially in elderly patients and during lengthy procedures, which carrying a higher risk for systolic blood pressure decline.

KW - Aged

KW - Blood Pressure/drug effects

KW - Cardiologists

KW - Catheter Ablation/methods

KW - Defibrillators, Implantable

KW - Female

KW - Germany

KW - Humans

KW - Hypnotics and Sedatives/administration & dosage

KW - Hypotension/chemically induced

KW - Male

KW - Midazolam/therapeutic use

KW - Middle Aged

KW - Propofol/administration & dosage

KW - Tachycardia, Ventricular/therapy

KW - Treatment Outcome

U2 - 10.1093/europace/euv303

DO - 10.1093/europace/euv303

M3 - SCORING: Journal article

C2 - 27247017

VL - 18

SP - 1245

EP - 1251

JO - EUROPACE

JF - EUROPACE

SN - 1099-5129

IS - 8

ER -