Skip to main content
SpringerLink
Log in

Impact of deep sedation on the electrophysiological behavior of pulmonary vein and non-PV firing during catheter ablation for atrial fibrillation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Catheter ablation for atrial fibrillation is performed with and without deep sedation, which could affect the arrhythmogenic activity during the procedure. We investigated the impact of sedation on electrophysiological properties in patients with AF who underwent catheter ablation.

Methods

This study consisted of 255 consecutive patients with atrial fibrillation (229 males, persistent: 105 patients) who underwent a single-catheter ablation procedure. The patients were divided into the following two groups according to the depth of sedation during the procedure: group M (mild sedation with flunitrazepam in 138 patients) and group D (deep sedation with propofol in 117 patients). Peripheral oxygen saturation was continuously monitored via pulse oximetry throughout the procedure.

Results

A spontaneous dissociated pulmonary vein activity after pulmonary vein isolation occurred more frequently in group M than in group D (29.1 vs 15.7%, P < 0.01). Adenosine-induced dormant pulmonary vein conduction was more frequently observed in group M than in group D (19.2 vs 13.0% P = 0.01). There were no significant differences in the incidence of non-pulmonary vein triggers between groups M and D (15.2 vs 11.1%, P = 0.53). The atrial fibrillation recurrence rate following the single procedure did not differ between the two groups (29.0 vs 26.5%, in groups M and D, P = 0.85).

Conclusions

Although deep sedation reduced the incidence of a dissociated pulmonary vein activity and dormant pulmonary vein conduction following pulmonary vein isolation, it did not affect the recurrence rate for atrial fibrillation after the procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation—a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the European Society of Cardiology Committee for practice guidelines (writing committee to revise the 2001 guidelines for the Management of Patients with Atrial Fibrillation). J Am Coll Cardiol. 2006;48:854–906.

    Article  PubMed  Google Scholar 

  2. Kannan S, Sherwood N. Termination of supraventricular tachycardia by propofol. Br J Anaesth. 2002;88:874–5.

    Article  CAS  PubMed  Google Scholar 

  3. Hermann R, Vettermann J. Change of ectopic supraventricular tachycardia to sinus rhythm during administration of propofol. Anesth Analg. 1992;75:1030–2.

    Article  CAS  PubMed  Google Scholar 

  4. Burjorjee JE, Milne B. Propofol for electrical storm; a case report of cardioversion and suppression of ventricular tachycardia by propofol. Can J Anaesth. 2002;49:973–7.

    Article  PubMed  Google Scholar 

  5. Mulpuru SK, Patel DV, Wilbur SL, Vasavada BC, Furqan T. Electrical storm and termination with propofol therapy: a case report. Int J Cardiol. 2008;128:e6–8.

    Article  PubMed  Google Scholar 

  6. Miro O, de la Red G, Fontanals J. Cessation of paroxysmal atrial fibrillation during acute intravenous propofol administration. Anesthesiology. 2000;92:910.

    Article  CAS  PubMed  Google Scholar 

  7. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Yamane T, Matsuo S, Date T, Lellouche N, Hioki M, Narui R, et al. Repeated provocation of time- and ATP-induced early pulmonary vein reconnections after pulmonary vein isolation: eliminating paroxysmal atrial fibrillation in a single procedure. Circ Arrhythm Electrophysiol. 2011;4:601–8.

    Article  PubMed  Google Scholar 

  9. Matsuo S, Yamane T, Date T, Inada K, Kanzaki Y, Tokuda M, et al. Reduction of AF recurrence after pulmonary vein isolation by eliminating ATP-induced transient venous re-conduction. J Cardiovasc Electrophysiol. 2007;18:704–8.

    Article  PubMed  Google Scholar 

  10. Matsuo S, Yamane T, Tokuda M, Date T, Hioki M, Narui R, et al. Prospective randomized comparison of a steerable versus a non-steerable sheath for typical atrial flutter ablation. Europace. 2010a;12:402–9.

    Article  PubMed  Google Scholar 

  11. Willems S, Weiss C, Risius T, Rostock T, Hoffmann M, Ventura R, et al. Dissociated activity and pulmonary vein fibrillation following functional disconnection: impact for the arrhythmogenesis of focal atrial fibrillation. Pacing Clin Electrophysiol. 2003;26:1363–70.

    Article  PubMed  Google Scholar 

  12. Lee G, Kalman JM, Vohra JK, Teh A, Medi C, Ling LH, et al. Dissociated pulmonary vein potentials following antral pulmonary vein isolation for atrial fibrillation: impact on long-term outcome. Heart. 2011;97:579–84.

    Article  PubMed  Google Scholar 

  13. Doi A, Satomi K, Makimoto H, Yokoyama T, Yamada Y, Okamura H, et al. Efficacy of additional radiofrequency applications for spontaneous dissociated pulmonary vein activity after pulmonary vein isolation in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2013;24:894–901.

    Article  PubMed  Google Scholar 

  14. Kurotobi T, Iwakura K, Inoue K, Kimura R, Okamura A, Koyama Y, et al. Multiple arrhythmogenic foci associated with the development of perpetuation of atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:39–45.

    Article  PubMed  Google Scholar 

  15. Hachiya H, Hirao K, Takahashi A, Nagata Y, Suzuki K, Maeda S, et al. Clinical implications of reconnection between the left atrium and isolated pulmonary veins provoked by adenosine triphosphate after extensive encircling pulmonary vein isolation. J Cardiovasc Electrophysiol. 2007;18:392–8.

    Article  PubMed  Google Scholar 

  16. Tritto M, De Ponti R, Salerno-Uriarte JA, Spadacini G, Marazzi R, Moretti P, et al. Adenosine restores atrio-venous conduction after apparently successful ostial isolation of the pulmonary veins. Eur Heart J. 2004;25:2155–263.

    Article  CAS  PubMed  Google Scholar 

  17. Murakami T, Yamaji H, Numa K, Kawamura H, Murakami M, Higashiya S, et al. Adaptive-servo ventilation combined with deep sedation is an effective strategy during pulmonary vein isolation. Europace. 2013;15:951–6.

    Article  PubMed  Google Scholar 

  18. Miyazaki S, Kuwahara T, Kobori A, Takahashi Y, Takei A, Sato A, et al. Impact of adenosine-provoked acute dormant pulmonary vein conduction on recurrence of atrial fibrillation. J Cardiovasc Electrophysiol. 2012;23:256–60.

    Article  PubMed  Google Scholar 

  19. Matsuo S, Yamane T, Date T, Hioki M, Ito K, Narui R, et al. Comparison of the clinical outcome after pulmonary vein isolation based on the appearance of adenosine-induced dormant pulmonary vein conduction. Am Heart J. 2010b;160:337–45.

    Article  PubMed  Google Scholar 

  20. Kottkamp H, Hindricks G, Eitel C, Müller K, Siedziako A, Koch J, et al. Deep sedation for catheter ablation of atrial fibrillation: a prospective study in 650 consecutive patients. J Cardiovasc Electrophysiol. 2011;22:1339–43.

    Article  PubMed  Google Scholar 

  21. Lü F, Lin J, Benditt DG. Conscious sedation and anesthesia in the cardiac electrophysiology laboratory. J Cardiovasc Electrophysiol. 2013;24:237–45.

    Article  PubMed  Google Scholar 

  22. Di Biase L, Conti S, Mohanty P, Bai R, Sanchez J, Walton D, et al. General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study. Heart Rhythm. 2011;8:368–72.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Dr. Brian Quinn (Editor-in-Chief, Japan Medical Communication) for providing linguistic comments on the manuscript.

Author information

Authors and Affiliations

  1. Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Ryohsuke Narui, Seiichiro Matsuo, Ryota Isogai, Kenichi Tokutake, Kenichi Yokoyama, Mika Kato, Keiichi Ito, Shin-ichi Tanigawa, Seigo Yamashita, Michifumi Tokuda, Keiichi Inada, Kenri Shibayama, Satoru Miyanaga, Kenichi Sugimoto, Michihiro Yoshimura & Teiichi Yamane

Authors
  1. Ryohsuke Narui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seiichiro Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryota Isogai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenichi Tokutake
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenichi Yokoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mika Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Keiichi Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shin-ichi Tanigawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Seigo Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michifumi Tokuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Keiichi Inada
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kenri Shibayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Satoru Miyanaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kenichi Sugimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Michihiro Yoshimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Teiichi Yamane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seiichiro Matsuo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Narui, R., Matsuo, S., Isogai, R. et al. Impact of deep sedation on the electrophysiological behavior of pulmonary vein and non-PV firing during catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 49, 51–57 (2017). https://doi.org/10.1007/s10840-017-0238-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-017-0238-6

Keywords

Search

Navigation