Calvert Peter, Mills Mark T, Murray Ben, Kendall Jonathan, Ratnasingham Justin, Luther Vishal, Gupta Dhiraj
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK.
J Interv Card Electrophysiol. 2025 Oct;68(7):1429-1436. doi: 10.1007/s10840-024-01961-1. Epub 2024 Dec 2.
Pulsed field ablation (PFA) is a new modality for pulmonary vein isolation (PVI) for atrial fibrillation (AF). PFA is performed under general anaesthetic (GA) or deep sedation with propofol, but this requires anaesthetic support in many countries, restricting use. No study has tested the feasibility of PFA under mild conscious sedation (MCS).
We prospectively recruited patients undergoing PFA PVI, offered the option of MCS delivered by electrophysiologists, and compared these with patients who opted for GA. MCS comprised intravenous midazolam and fentanyl. All procedures were performed under anaesthetic supervision in case of requirement to convert to GA, which formed the primary outcome.
Twenty-three patients were recruited (8 MCS, 15 GA). One patient (1/8 [12.5%]) required conversion from MCS to GA. Total procedural times were similar between groups (MCS 92 ± 12.4 min vs. GA 101 ± 17.3 min; p = 0.199). High mean sedative doses were required in the MCS group (5.12 ± 0.83 mg midazolam and 209 ± 40 mcg fentanyl). Median intraprocedural pain perception by the patient, rated from 0 to 100 was 45 (IQR 22.5-72.5) in the MCS group. Post-procedural groin pain (0 [0-0] vs. 5 [0-35]; p = 0.027) and throat pain (0 [0-0] vs. 10 [5-40]; p = 0.001) were lower in the MCS group.
PFA under MCS is feasible in selected patients but pain and tolerance may be suboptimal, and high sedative doses are required.
脉冲场消融（PFA）是一种用于心房颤动（AF）肺静脉隔离（PVI）的新方法。PFA在全身麻醉（GA）或丙泊酚深度镇静下进行，但在许多国家这需要麻醉支持，限制了其应用。尚无研究测试轻度清醒镇静（MCS）下PFA的可行性。
我们前瞻性招募接受PFA PVI的患者，提供由电生理学家实施MCS的选择，并将这些患者与选择GA的患者进行比较。MCS包括静脉注射咪达唑仑和芬太尼。所有手术均在麻醉监督下进行，以防需要转为GA，这构成主要结局。
招募了23名患者（8名接受MCS，15名接受GA）。1名患者（1/8 [12.5%]）需要从MCS转为GA。两组的总手术时间相似（MCS组92±12.4分钟 vs. GA组101±17.3分钟；p = 0.199）。MCS组需要较高的平均镇静剂量（5.12±0.83毫克咪达唑仑和209±40微克芬太尼）。MCS组患者术中疼痛感知中位数（0至100评分）为45（四分位间距22.5 - 72.5）。MCS组术后腹股沟疼痛（0 [下限 - 上限] vs. 5 [0 - 35]；p = 0.027）和咽痛（0 [下限 - 上限] vs. 10 [5 - 40]；p = 0.001）较低。
在选定患者中，MCS下的PFA是可行的，但疼痛和耐受性可能不理想，且需要较高的镇静剂量。
