Tomita Yasuhiro, Kimura Yuka, Kasagi Satoshi, Kasai Takatoshi
Sleep Center, Toranomon Hospital, 105-8470 Tokyo, Japan.
Cardiovascular Center, Toranomon Hospital, 105-8470 Tokyo, Japan.
Rev Cardiovasc Med. 2022 Apr 1;23(4):121. doi: 10.31083/j.rcm2304121. eCollection 2022 Apr.
Abnormal respiration during radiofrequency catheter ablation (RFCA) with deep sedation in patients with atrial fibrillation (AF) can affect the procedure's success. However, the respiratory pattern during RFCA with deep sedation remains unclear. This study aimed to investigate abnormal respiration during RFCA and its relationship with sleep apnea in patients with AF.
We included patients with AF who underwent RFCA with cardiorespiratory monitoring using a portable polygraph both at night and during RFCA with deep sedation. The patients were divided based on the administered sedative medicines.
We included 40 patients with AF. An overnight sleep study revealed that 27 patients had sleep apnea; among them, 9 showed central predominance. During RFCA with deep sedation, 15 patients showed an abnormal respiratory pattern, with 14 patients showing obstructive predominance. Further, 17 and 23 patients were administered with propofol alone and dexmedetomidine plus propofol, respectively. There was no significant between-group difference in the respiratory event index (REI) at night (7.9 vs. 9.3, = 0.744). However, compared with the group that received dexmedetomidine plus propofol, the propofol-alone group showed a higher REI during RFCA (5.4 vs. 2.6, = 0.048), more frequent use of the airway (47% vs. 13%, = 0.030), and a higher dose of administered propofol (3.9 mg/h/kg vs. 1.2 mg/h/kg, 0.001). Multivariable analysis revealed that only the propofol amount was associated with REI during RFCA ( = 0.007).
Our findings demonstrated that respiratory events during RFCA with deep sedation were mainly obstructive. Propofol should be administered with dexmedetomidine rather than alone to reduce the propofol amount and avoid respiratory instability.
心房颤动（AF）患者在深度镇静下进行射频导管消融术（RFCA）期间的异常呼吸会影响手术的成功率。然而，深度镇静下RFCA期间的呼吸模式仍不清楚。本研究旨在调查AF患者RFCA期间的异常呼吸及其与睡眠呼吸暂停的关系。
我们纳入了在夜间和深度镇静下进行RFCA时使用便携式多导睡眠图进行心肺监测的AF患者。根据所使用的镇静药物对患者进行分组。
我们纳入了40例AF患者。一项夜间睡眠研究显示，27例患者有睡眠呼吸暂停；其中9例以中枢性为主。在深度镇静下进行RFCA期间，15例患者出现异常呼吸模式，其中14例以阻塞性为主。此外，分别有17例和23例患者单独使用丙泊酚和右美托咪定加丙泊酚。夜间呼吸事件指数（REI）在两组之间无显著差异（7.9对9.3，P = 0.744）。然而，与接受右美托咪定加丙泊酚的组相比，单独使用丙泊酚的组在RFCA期间的REI更高（5.4对2.6，P = 0.048），气道使用更频繁（47%对13%，P = 0.030），丙泊酚给药剂量更高（3.9 mg/h/kg对1.2 mg/h/kg，P < 0.001）。多变量分析显示，只有丙泊酚用量与RFCA期间的REI相关（P = 0.007）。
我们的研究结果表明，深度镇静下RFCA期间的呼吸事件主要是阻塞性的。丙泊酚应与右美托咪定联合使用而非单独使用，以减少丙泊酚用量并避免呼吸不稳定。
