Narui Ryohsuke, Matsuo Seiichiro, Isogai Ryota, Tokutake Kenichi, Yokoyama Kenichi, Kato Mika, Ito Keiichi, Tanigawa Shin-Ichi, Yamashita Seigo, Tokuda Michifumi, Inada Keiichi, Shibayama Kenri, Miyanaga Satoru, Sugimoto Kenichi, Yoshimura Michihiro, Yamane Teiichi
Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
J Interv Card Electrophysiol. 2017 Jun;49(1):51-57. doi: 10.1007/s10840-017-0238-6. Epub 2017 Mar 11.
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.
心房颤动导管消融术在有或没有深度镇静的情况下进行，这可能会影响手术过程中的致心律失常活性。我们研究了镇静对接受导管消融术的房颤患者电生理特性的影响。
本研究纳入了255例连续接受单导管消融术的心房颤动患者（男性229例，持续性房颤：105例）。根据手术过程中的镇静深度将患者分为以下两组：M组（138例患者使用氟硝西泮进行轻度镇静）和D组（117例患者使用丙泊酚进行深度镇静）。在整个手术过程中通过脉搏血氧饱和度仪持续监测外周血氧饱和度。
肺静脉隔离后，M组比D组更频繁地出现自发的离断肺静脉活动（29.1%对15.7%，P<0.01）。M组比D组更频繁地观察到腺苷诱导的潜伏性肺静脉传导（19.2%对13.0%，P=0.01）。M组和D组之间非肺静脉触发灶的发生率无显著差异（15.2%对11.1%，P=0.53）。两组单次手术后的房颤复发率无差异（M组和D组分别为29.0%和26.5%，P=0.85）。
尽管深度镇静降低了肺静脉隔离后离断肺静脉活动和潜伏性肺静脉传导的发生率，但它并未影响手术后房颤的复发率。
