Department for Cardiac Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany
Department for Cardiac Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany.
Europace. 2016 Aug;18(8):1245-51. doi: 10.1093/europace/euv303. Epub 2016 May 30.
Propofol sedation has been shown to be safe for atrial fibrillation ablation and internal cardioverter-defibrillator implantation but its use for catheter ablation (CA) of ventricular tachycardia (VT) has yet to be evaluated. Here, we tested the hypothesis that VT ablation can be performed using propofol sedation administered by trained nurses under a cardiologist's supervision.
Data of 205 procedures (157 patients, 1.3 procedures/patient) undergoing CA for sustained VT under propofol sedation were analysed. The primary endpoint was change of sedation and/or discontinuation of propofol sedation due to side effects and/or haemodynamic instability. Propofol cessation was necessary in 24 of 205 procedures. These procedures (Group A; n = 24, 11.7%) were compared with those with continued propofol sedation (Group B; n = 181, 88.3%). Propofol sedation was discontinued due to hypotension (n = 22; 10.7%), insufficient oxygenation (n = 1, 0.5%), or hypersalivation (n = 1, 0.5%). Procedures in Group A were significantly longer (210 [180-260] vs. 180 [125-220] min, P = 0.005), had a lower per hour propofol rate (3.0 ± 1.2 vs. 3.8 ± 1.2 mg/kg of body weight/h, P = 0.004), and higher cumulative dose of fentanyl administered (0.15 [0.13-0.25] vs. 0.1 [0.05-0.13] mg, P < 0.001), compared with patients in Group B. Five (2.4%) adverse events occurred.
Sedation using propofol can be safely performed for VT ablation under the supervision of cardiologists. Close haemodynamic monitoring is required, especially in elderly patients and during lengthy procedures, which carrying a higher risk for systolic blood pressure decline.
丙泊酚镇静已被证明可安全用于房颤消融和内置心脏除颤器植入，但尚未评估其在室性心动过速（VT）导管消融（CA）中的应用。在这里，我们检验了以下假设，即 VT 消融可以在心脏病专家的监督下由经过培训的护士使用丙泊酚镇静来进行。
分析了 205 例接受丙泊酚镇静下持续性 VT CA 的 205 例（157 例患者，1.3 例/例）患者的数据。主要终点是因副作用和/或血液动力学不稳定而改变镇静和/或停止丙泊酚镇静。205 例中有 24 例需要停止丙泊酚。这些程序（A 组；n = 24，11.7%）与继续使用丙泊酚镇静的程序（B 组；n = 181，88.3%）进行比较。丙泊酚镇静因低血压（n = 22；10.7%）、氧合不足（n = 1，0.5%）或唾液分泌过多（n = 1，0.5%）而停止。A 组的手术时间明显较长（210[180-260]比 180[125-220]min，P = 0.005），每小时丙泊酚用量较低（3.0±1.2比 3.8±1.2mg/kg体重/h，P = 0.004），芬太尼累积剂量较高（0.15[0.13-0.25]比 0.1[0.05-0.13]mg，P < 0.001）。与 B 组患者相比。5 例（2.4%）发生不良事件。
在心脏病专家的监督下，使用丙泊酚镇静可安全用于 VT 消融。需要密切监测血液动力学，尤其是在老年患者和手术时间较长的情况下，这会增加收缩压下降的风险。
