Electrophysiology Unit, GVM Care&Research, Maria Cecilia Hospital, Cotignola, 48033 RA, Italy.
Medical Education & Scientific Affairs, Boston Scientific, 20134, Milan, Italy.
Europace. 2023 Aug 2;25(9). doi: 10.1093/europace/euad230.
A standardized sedation protocol for pulsed-field ablation (PFA) of atrial fibrillation (AF) through irreversible cellular electroporation has not been well established. We report our experience of a protocol for deep sedation with ketamine in spontaneous respiration during the PFA of AF.
All consecutive patients undergoing PFA for AF at our center were included. Our sedation protocol involves the intravenous administration of fentanyl (1.5 mcg/kg) and midazolam (2 mg) at low doses before local anesthesia with lidocaine. A ketamine adjunct (1 mg/kg) was injected about 5 minutes before the first PFA delivery. We enrolled 66 patients (age = 59 ± 9 years, 78.8% males, body mass index = 28.8 ± 5 kg/m2, fluoroscopy time = 21[15-30] min, skin-to-skin time = 75[60-100] min and PFA LA dwell time = 25[22-28] min). By the end of the procedure, PVI had been achieved in all patients by means of PFA alone. The mean time under sedation was 56.4 ± 6 min, with 50 (76%) patients being sedated for less than 1 hour. A satisfactory Ramsey Sedation Scale level before ketamine infusion was achieved in all patients except one (78.8% of the patients with rank 3; 19.7% with rank 2). In all procedures, the satisfaction level was found to be acceptable by both the patient and the primary operator (Score = 0 in 98.5% of cases). All patients reported none or mild pain. No major procedure or anesthesia-related complications were reported.
Our standardized sedation protocol with the administration of drugs with rapid onset and pharmacological offset at low doses was safe and effective, with an optimal degree of patient and operator satisfaction.
Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA). URL: http://clinicaltrials.gov/Identifier: NCT05617456.
通过不可逆的细胞电穿孔对心房颤动（AF）进行脉冲场消融（PFA）尚未建立标准化的镇静方案。我们报告了在 AF 的 PFA 过程中，通过自然呼吸给予氯胺酮进行深度镇静的方案。
纳入在我们中心接受 AF 的 PFA 的所有连续患者。我们的镇静方案包括在局部麻醉前给予小剂量的芬太尼（1.5 mcg/kg）和咪达唑仑（2 mg）。在第一次 PFA 输送前约 5 分钟，给予氯胺酮辅助（1 mg/kg）。我们纳入了 66 例患者（年龄=59±9 岁，78.8%为男性，体重指数=28.8±5 kg/m2，透视时间=21[15-30]min，皮肤到皮肤时间=75[60-100]min，PFA LA 停留时间=25[22-28]min）。在手术结束时，所有患者均通过单独的 PFA 实现了 PVI。镇静时间的平均值为 56.4±6 min，50 例（76%）患者的镇静时间少于 1 小时。除 1 例患者（78.8%为 3 级；19.7%为 2 级）外，所有患者在给予氯胺酮前均达到满意的 Ramsey 镇静评分水平。在所有程序中，患者和主要操作人员都发现满意度可接受（98.5%的情况下评分=0）。所有患者均报告无疼痛或轻度疼痛。未报告重大手术或麻醉相关并发症。
我们的镇静方案是安全有效的，以快速起效和药理学消退为特点，以低剂量给药，患者和操作人员满意度均达到最佳水平。
高级技术在临床实践中成功消融 AF（ATHENA）。网址：http://clinicaltrials.gov/标识符：NCT05617456。
