Propofol sedation administered by cardiologists without assisted ventilation for long cardiac interventions: an assessment of 1000 consecutive patients undergoing atrial fibrillation ablation

TY - JOUR

T1 - Propofol sedation administered by cardiologists without assisted ventilation for long cardiac interventions: an assessment of 1000 consecutive patients undergoing atrial fibrillation ablation

AU - Salukhe, Tushar Vilas

AU - Willems, Stephan

AU - Drewitz, Imke

AU - Steven, Daniel

AU - Hoffmann, Boris A

AU - Heitmann, Katrin

AU - Rostock, Thomas

PY - 2012/3

Y1 - 2012/3

N2 - AIMS: Patients can expect a cure from atrial fibrillation (AF) with ablation. Procedural safety and success depend on patient comfort, compliance, and immobility. This is difficult to achieve with benzodiazepine and opiate boluses that are the mainstay of current practice. We sought to determine the safety and efficacy of propofol infusion sedation administered to patients without assisted ventilation for AF ablation.METHODS AND RESULTS: Procedural data from 1000 consecutive patients undergoing AF ablation were analysed. Sedation with 2% propofol was used in all procedures without assisted ventilation and was administered, monitored, and controlled by electrophysiologists. Primary outcome measures were adverse sedative affects including (i) respiratory depression (SpO(2)< 90% for >20 s) and (ii) persistent hypotension [systolic blood pressure (SBP)<90 mmHg at minimum sedation level]. Secondary endpoints included full recovery within 60 min and procedural complications. Of 1000 ablations, 506 ablations were performed for persistent and 494 for paroxysmal AF. Average patient age was 60.1 ± 11.3 years (72.3% male). Propofol was commenced in all patients at a mean infusion rate of 18.5 ± 4.8 mL/h with a mean baseline SBP of 140.3 ± 19.9 mmHg. Mean procedure time was 148.7 ± 57.7 min. Adverse sedative effects necessitating cessation of propofol and switch to midazolam bolus sedation occurred in 15.6% of patients (13.6% due to persistent hypotension, 1.9% due to respiratory depression, and 0.1% due to hypersalivation). Patients who had persistent hypotension were older (62.9 ± 11.2 vs. 60.0 ± 11.4 years, P= 0.011) and more likely to be female (39.5 vs. 23.7%, P< 0.001) than those who tolerated propofol. Patient age correlated to maximum blood pressure drop with propofol (R(2)= 0.101, P< 0.001) and inversely correlated to mean propofol infusion rate (R(2)= 0.066, P< 0.001). No procedures were abandoned due to adverse effects of sedation. All patients recovered within 60 min. Serious procedural complications, unrelated to sedation, occurred in 0.5%, all of whom had pericardial tamponade successfully treated with percutaneous pericardiocentesis.CONCLUSIONS: Sedation with 2% propofol infusion administered by cardiologists without assisted ventilation is safe, effective, and practical for use in AF ablation without serious or residual complications. In this setting, persistent hypotension is the most common acute adverse effect requiring cessation of propofol in ∼14%.

AB - AIMS: Patients can expect a cure from atrial fibrillation (AF) with ablation. Procedural safety and success depend on patient comfort, compliance, and immobility. This is difficult to achieve with benzodiazepine and opiate boluses that are the mainstay of current practice. We sought to determine the safety and efficacy of propofol infusion sedation administered to patients without assisted ventilation for AF ablation.METHODS AND RESULTS: Procedural data from 1000 consecutive patients undergoing AF ablation were analysed. Sedation with 2% propofol was used in all procedures without assisted ventilation and was administered, monitored, and controlled by electrophysiologists. Primary outcome measures were adverse sedative affects including (i) respiratory depression (SpO(2)< 90% for >20 s) and (ii) persistent hypotension [systolic blood pressure (SBP)<90 mmHg at minimum sedation level]. Secondary endpoints included full recovery within 60 min and procedural complications. Of 1000 ablations, 506 ablations were performed for persistent and 494 for paroxysmal AF. Average patient age was 60.1 ± 11.3 years (72.3% male). Propofol was commenced in all patients at a mean infusion rate of 18.5 ± 4.8 mL/h with a mean baseline SBP of 140.3 ± 19.9 mmHg. Mean procedure time was 148.7 ± 57.7 min. Adverse sedative effects necessitating cessation of propofol and switch to midazolam bolus sedation occurred in 15.6% of patients (13.6% due to persistent hypotension, 1.9% due to respiratory depression, and 0.1% due to hypersalivation). Patients who had persistent hypotension were older (62.9 ± 11.2 vs. 60.0 ± 11.4 years, P= 0.011) and more likely to be female (39.5 vs. 23.7%, P< 0.001) than those who tolerated propofol. Patient age correlated to maximum blood pressure drop with propofol (R(2)= 0.101, P< 0.001) and inversely correlated to mean propofol infusion rate (R(2)= 0.066, P< 0.001). No procedures were abandoned due to adverse effects of sedation. All patients recovered within 60 min. Serious procedural complications, unrelated to sedation, occurred in 0.5%, all of whom had pericardial tamponade successfully treated with percutaneous pericardiocentesis.CONCLUSIONS: Sedation with 2% propofol infusion administered by cardiologists without assisted ventilation is safe, effective, and practical for use in AF ablation without serious or residual complications. In this setting, persistent hypotension is the most common acute adverse effect requiring cessation of propofol in ∼14%.

KW - Aged

KW - Anesthetics, Intravenous/adverse effects

KW - Atrial Fibrillation/surgery

KW - Cardiac Tamponade/surgery

KW - Catheter Ablation/methods

KW - Cohort Studies

KW - Deep Sedation/methods

KW - Female

KW - Humans

KW - Hypotension/chemically induced

KW - Male

KW - Midazolam/therapeutic use

KW - Middle Aged

KW - Pericardiocentesis

KW - Propofol/adverse effects

KW - Respiratory Insufficiency/chemically induced

KW - Sialorrhea/chemically induced

KW - Treatment Outcome

U2 - 10.1093/europace/eur328

DO - 10.1093/europace/eur328

M3 - SCORING: Journal article

C2 - 22024600

VL - 14

SP - 325

EP - 330

JO - EUROPACE

JF - EUROPACE

SN - 1099-5129

IS - 3

ER -