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Transcutaneous carbon dioxide monitoring to avoid hypercapnia during complex catheter ablations: a feasibility study

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Abstract

Purpose

The aim of this study was to determine if transcutaneous CO2 monitoring (TCO2) is feasible to avoid hypercapnia during complex catheter ablation. Cumulative analgesic and anxiolytic effects during complex catheter ablation can rarely provoke hypoventilation and respiratory complications. End tidal CO2 monitors have limitations in non-ventilated patients, and frequent arterial blood gas sampling is impractical.

Methods

Consecutive patients undergoing catheter ablation for atrial fibrillation (AF) or ventricular tachycardia (VT) received continuous TCO2 monitoring. Procedural evaluation of TCO2 was performed concomitantly with point-of-care arterial blood gas testing. Endpoints included PCO2 protocol feasibility, TCO2/PCO2 agreement, and avoidance of hypercapnia-related procedural complications.

Results

Fifty patients [AF n = 36 (72 %), VT n = 14 (28 %)] underwent catheter ablation (mean 221.7 ± 57.0 min duration, median 41.4 ± 21.1 min fluoroscopy) in which 6.0 ± 2.6 mg midazolam and 449 ± 225.5 mcg of fentanyl were administered. Monitoring protocol implementation was feasible in 50/50 (100 %) cases. Protocol-driven anesthesia consultation avoided an unplanned intubation in 1 case (2 %) and there was only 1 unplanned intubation (2 %) for oxygen desaturation due to heart failure without hypercapnia during a VT ablation (TCO2/PCO2 agreement <5 mmHg). There were no respiratory or pulseless electrical arrests (0 %) in the study. TCO2 and PCO2 correlated well (baseline: r = 0.75, p < 0.001; 1 h:r= 0.72, p < 0.001; 2 h: r = 0.55, p = 0.003; 3 h: r = 0.79, p = 0.02). However, desired agreement was lower than expected [baseline: 33/50 (66 %) < 5 mmHg, 48/50 (96 %) <10 mmHg; 1 h: 29/45 (64 %) < 5 mmHg, 39/45 (87 %) < 10 mmHg; 2 h: 14/26 (54 %) < 5 mmHg, 22/26 (85 %) < 10 mmHg; 3 h: 7/11 (64 %) < 5 mmHg, 10/11 (91 %) < 10 mmHg; >3 h: 1/3 (33 %) < 5 mmHg, 2/3 (66 %) < 10 mmHg].

Conclusion

Transcutaneous CO2 monitoring is feasible during complex catheter ablation and correlates with invasively obtained data. However, further development is needed to achieve the desired level of agreement.

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Authors and Affiliations

  1. Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J2-2, Cleveland, OH, 44195, USA

    Daniel J. Cantillon, Lisa M. Keene, Ali Hakim, Stephanie Spencer, Jennifer Petro, Mary Ludvik & Dawn Schell

Authors
  1. Daniel J. Cantillon
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  2. Lisa M. Keene
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  3. Ali Hakim
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  4. Stephanie Spencer
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  5. Jennifer Petro
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  6. Mary Ludvik
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  7. Dawn Schell
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Correspondence to Daniel J. Cantillon.

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Cantillon, D.J., Keene, L.M., Hakim, A. et al. Transcutaneous carbon dioxide monitoring to avoid hypercapnia during complex catheter ablations: a feasibility study. J Interv Card Electrophysiol 43, 307–311 (2015). https://doi.org/10.1007/s10840-015-0013-5

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  • DOI: https://doi.org/10.1007/s10840-015-0013-5

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