Wutzler Alexander, Loehr Lena, Huemer Martin, Parwani Abdul Shokor, Steinhagen-Thiessen Elisabeth, Boldt Leif-Hendrik, Haverkamp Wilhelm
Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
J Interv Card Electrophysiol. 2013 Nov;38(2):115-21. doi: 10.1007/s10840-013-9817-3. Epub 2013 Sep 8.
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.
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.
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).
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.
心房颤动（AF）是最常见的心律失常。AF的发病率随年龄增长而增加。AF消融手术通常在丙泊酚深度镇静下进行。本研究的目的是评估AF消融术中丙泊酚深度镇静对老年患者是否安全。
连续纳入401例因有症状的AF前来我院进行消融治疗的患者（平均年龄61.4±11.1岁；范围20 - 82岁；男性占66.3%）。患者分为三组：A组患者年龄≤50岁；B组患者年龄为51 - 74岁；C组患者年龄≥75岁。手术在丙泊酚、咪达唑仑和匹利卡明深度镇静下进行。整个手术过程中监测血氧饱和度（SaO2）、心电图、动脉血压和动脉血气。评估镇静相关并发症、术中并发症及其他不良事件。采用Fisher精确检验或χ²检验比较各组间的不良事件和并发症。采用方差分析比较镇静和手术相关参数。
C组有53例（13.2%）老年患者，与A组的73例（18.2%）患者和B组的275例（68.8%）患者进行比较。在镇静相关或术中并发症方面未见显著差异（A组1.4%；B组1.1%；C组3.7%；p = 0.336）。尽管C组在镇静过程中收缩压下降幅度显著更大（A组15.5±9.5 mmHg；B组18.9±16.3 mmHg；C组32.3±15.5 mmHg；p < 0.001），但未观察到持续性低血压。C组其他不良事件（谵妄、呼吸道感染、肾衰竭）的发生率（9.4%）显著高于A组（0%）和B组（2.2%；p = 0.004）。
AF消融术中丙泊酚和咪达唑仑深度镇静未导致老年患者镇静相关并发症发生率增加。同样，各研究组间手术并发症发生率无显著差异。老年人呼吸道感染和肾衰竭的发生率显著更高。所有不良事件均得到成功治疗，无任何后遗症。
