Skip to main content

Advertisement

SpringerLink
Log in

Deep sedation during catheter ablation for atrial fibrillation in elderly patients

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

Abstract

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia. AF incidence increases with age. AF ablation procedures are routinely performed under deep sedation with propofol. The purpose of the study was to evaluate if propofol deep sedation during AF ablation is safe in elderly patients.

Methods

Four hundred one consecutive patients (mean age, 61.4 ± 11.1 years; range, 20–82; 66.3 % men) who were presented to our institution for ablation of symptomatic AF were enrolled. Patients were divided into three groups: Patients in group A were ≤50 years old; patients in group B were 51–74 years old; and patients in group C were ≥75 years old. Procedures were performed under deep sedation with propofol, midazolam, and piritramide. SaO2, electrocardiogram, arterial blood pressure, and arterial blood gas were monitored throughout the procedure. Sedation-related complications, intraprocedural complications, and other adverse events were evaluated. Fisher exact or χ 2 tests were used for comparison of adverse events and complications among groups. Analysis of variance was used to compare sedation- and procedure-related parameters.

Results

Fifty-three (13.2 %) elderly patients were in group C and were compared to 73 (18.2 %) patients in group A and 275 (68.8 %) in group B. No significant differences in sedation-related or intraprocedural complications were seen (group A, 1.4 %; group B, 1.1 %; group C, 3.7 %; p = 0.336). Despite a significantly greater drop in systolic blood pressure in under sedation in group C (group A, 15.5 ± 9.5 mmHg; group B, 18.9 ± 16.3 mmHg; group C, 32.3 ± 15.5 mmHg; p < 0.001), no prolonged hypotension was observed. The rate of other adverse events (delirium, respiratory infection, renal failure) was significantly higher in group C (9.4 %), compared to group A (0 %) and group B (2.2 %; p = 0.004).

Conclusion

Deep sedation with propofol and midazolam during AF ablation did not result in an increased rate in sedation-related complications in elderly patients. Similarly, the rate of procedural complications was not significantly different among the study groups. The rate of respiratory infections and renal failure was significantly higher in the elderly. All adverse events were treated successfully without any remaining sequelae.

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

Similar content being viewed by others

References

  1. Camm, A. J., Lip, G. Y., De Caterina, R., Savelieva, I., Atar, D., Hohnloser, S. H., et al. (2012). 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. European Heart Journal, 33(21), 2719–2747.

    Article  PubMed  Google Scholar 

  2. Miyasaka, Y., Barnes, M. E., Gersh, B. J., Cha, S. S., Bailey, K. R., Abhayaratna, W. P., et al. (2006). Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation, 114(2), 119–125.

    Article  PubMed  Google Scholar 

  3. Reynolds, M. R., & Essebag, V. (2012). Economic burden of atrial fibrillation: implications for intervention. American Journal of Pharmacy Benefits, 4(2), 58–65.

    Google Scholar 

  4. Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Journal of Interventional Cardiac Electrophysiology, 33, 171–257.

    Article  PubMed  Google Scholar 

  5. Yamada, T., & Kay, G. N. (2009). Catheter ablation of atrial fibrillation in the elderly. Pacing and Clinical Electrophysiology, 32(8), 1085–1091.

    Article  PubMed  Google Scholar 

  6. Miner, J. R., & Burton, J. H. (2007). Clinical practice advisory: emergency department procedural sedation with propofol. Annals of Emergency Medicine, 50(2), 182–187.

    Article  PubMed  Google Scholar 

  7. Coté, G. A., Hovis, R. M., Ansstas, M. A., Waldbaum, L., Azar, R. R., Early, D. S., Edmundowicz, S. A., Mullady, D. K., Jonnalagadda, S. S., et al. (2010). Incidence of sedation-related complications with propofol use during advanced endoscopic procedures. Clinical Gastroenterology and Hepatology, 8(2), 137–142.

    Article  PubMed  Google Scholar 

  8. Lü, F., Lin, J., & Benditt, D. G. (2013). Conscious sedation and anesthesia in the cardiac electrophysiology laboratory. Journal of Cardiovascular Electrophysiology, 24, 237–245.

    Article  PubMed  Google Scholar 

  9. Wutzler, A., Rolf, S., Huemer, M., Parwani, A. S., Boldt, L. H., Herberger, E., et al. (2012). Safety aspects of deep sedation during catheter ablation of atrial fibrillation. Pacing and Clinical Electrophysiology, 35, 38–43.

    Article  PubMed  Google Scholar 

  10. Salukhe, T. V., Willems, S., Drewitz, I., Steven, D., Hoffmann, B. A., Heitmann, K., et al. (2012). Propofol sedation administered by cardiologists without assisted ventilation for long cardiac interventions: an assessment of 1000 consecutive patients undergoing atrial fibrillation ablation. Europace, 14(3), 325–330.

    Article  PubMed  Google Scholar 

  11. Kottkamp, H., Hindricks, G., Eitel, C., Müller, K., Siedziako, A., Koch, J., et al. (2011). Deep sedation for catheter ablation of atrial fibrillation: a prospective study in 650 consecutive patients. Journal of Cardiovascular Electrophysiology, 22(12), 1339–1343.

    Article  PubMed  Google Scholar 

  12. Rostykus, P. S., McDonald, G. B., & Albert, R. K. (1980). Upper intestinal endoscopy induces hypoxemia in patients with obstructive pulmonary disease. Gastroenterology, 78, 488–491.

    PubMed  CAS  Google Scholar 

  13. Nishikawa, K., Kanaya, N., Kawamata, M., & Namiki, A. (2004). Left ventricular mechanical performance in elderly patients after induction of anaesthesia. A comparison of inhalational induction with sevoflurane and intravenous induction with fentanyl and propofol. Anaesthesia, 59(10), 948–953.

    Article  PubMed  CAS  Google Scholar 

  14. Tang, R. B., Dong, J. Z., Zhao, W. D., Liu, X. P., Kang, J. P., Long, D. Y., et al. (2007). Unconscious sedation/analgesia with propofol versus conscious sedation with fentanyl/midazolam for catheter ablation of atrial fibrillation: a prospective, randomized study. Chinese Medical Journal, 120, 2036–2038.

    PubMed  CAS  Google Scholar 

  15. Raftery, S., & Sherry, E. (1992). Total intravenous anaesthesia with propofol and alfentanil protects against postoperative nausea and vomiting. Canadian Journal of Anaesthesia, 39, 37–40.

    Article  PubMed  CAS  Google Scholar 

  16. Nishikawa, K., Nakayama, M., Omote, K., & Namiki, A. (2004). Recovery characteristics and post-operative delirium after long-duration laparoscope-assisted surgery in elderly patients: propofol-based vs. sevoflurane-based anesthesia. Acta Anaesthesiologica Scandinavica, 48(2), 162–168.

    Article  PubMed  CAS  Google Scholar 

  17. Beller, J. P., Pottecher, T., Mangin, P., Fratte, C., & Otteni, J. C. (1987). Long-term sedation with propofol during intensive care. Preliminary results of the recovery and pharmacokinetics. Annales Françaises d’Anesthésie et de Réanimation, 6, 334–335.

    Article  PubMed  CAS  Google Scholar 

  18. Weaver, C. S., Terrell, K. M., Bassett, R., Swiler, W., Sandford, B., Avery, S., et al. (2011). ED procedural sedation of elderly patients: is it safe? The American Journal of Emergency Medicine, 29(5), 541–544.

    Article  PubMed  Google Scholar 

  19. Piccini, J. P., Sinner, M. F., Greiner, M. A., Hammill, B. G., Fontes, J. D., Daubert, J. P., et al. (2012). Outcomes of medicare beneficiaries undergoing catheter ablation for atrial fibrillation. Circulation, 126(18), 2200–2207.

    Article  PubMed  Google Scholar 

  20. Kusumoto, F., Prussak, K., Wiesinger, M., Pullen, T., & Lynady, C. (2009). Radiofrequency catheter ablation of atrial fibrillation in older patients: outcomes and complications. Journal of Interventional Cardiac Electrophysiology, 25(1), 31–35.

    Article  PubMed  Google Scholar 

  21. Evans, C. T., LaVela, S. L., Weaver, F. M., Priebe, M., Sandford, P., Niemiec, P., et al. (2008). Epidemiology of hospital-acquired infections in veterans with spinal cord injury and disorder. Infection Control and Hospital Epidemiology, 29(3), 234–242.

    Article  PubMed  Google Scholar 

  22. Laurent, M., Bories, P. N., Le Thuaut, A., Liuu, E., Ledudal, K., Bastuji-Garin, S., et al. (2012). Impact of comorbidities on hospital-acquired infections in a geriatric rehabilitation unit: prospective study of 252 patients. Journal of the American Medical Directors Association, 13(8), 760.e7–760.e12.

    Article  Google Scholar 

  23. Kikuchi, R., Watabe, N., Konno, T., Mishina, N., Sekizawa, K., & Sasaki, H. (1994). High incidence of silent aspiration in elderly patients with community acquired pneumonia. American Journal of Respiratory and Critical Care Medicine, 150(1), 251–253.

    Article  PubMed  CAS  Google Scholar 

  24. Bowles, C. J., Leicester, R., Romaya, C., Swarbrick, E., Williams, C. B., & Epstein, O. (2004). A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? Gut, 53(2), 277–283.

    Article  PubMed  CAS  Google Scholar 

  25. Marik, P. E. (2001). Aspiration pneumonitis and aspiration pneumonia. The New England Journal of Medicine, 344(9), 665–671.

    Article  PubMed  CAS  Google Scholar 

  26. Green, S. M., & Krauss, B. (2002). Pulmonary aspiration risk during emergency department procedural sedation—an examination of the role of fasting and sedation depth. Academic Emergency Medicine, 9(1), 35–42.

    PubMed  Google Scholar 

Download references

Conflict of interest

All authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Cardiology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Alexander Wutzler, Lena Loehr, Martin Huemer, Abdul Shokor Parwani, Leif-Hendrik Boldt & Wilhelm Haverkamp

  2. Department of Geriatrics and Lipid Disorders, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany

    Elisabeth Steinhagen-Thiessen

Authors
  1. Alexander Wutzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lena Loehr
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Huemer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdul Shokor Parwani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elisabeth Steinhagen-Thiessen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leif-Hendrik Boldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wilhelm Haverkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander Wutzler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wutzler, A., Loehr, L., Huemer, M. et al. Deep sedation during catheter ablation for atrial fibrillation in elderly patients. J Interv Card Electrophysiol 38, 115–121 (2013). https://doi.org/10.1007/s10840-013-9817-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-013-9817-3

Keywords

Search

Navigation