Impact of deep sedation on the electrophysiological behavior of pulmonary vein and non-PV firing during catheter ablation for atrial fibrillation
- 304 Downloads
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.
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.
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).
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.
KeywordsAtrial fibrillation Catheter ablation Deep sedation Electrophysiological property Propofol Pulmonary vein Non-pulmonary vein foci
We are grateful to Dr. Brian Quinn (Editor-in-Chief, Japan Medical Communication) for providing linguistic comments on the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 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.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle Scholar