title: Adaptive-servo ventilation combined with deep sedation is an effective strategy during pulmonary vein isolation.
abstract: OBJECTIVE
  Pulmonary vein isolation (PVI) by catheter ablation for atrial fibrillation (AF) requires suppression of patient restlessness by sufficient sedation in addition to maintaining stable respiration. We applied adaptive-servo ventilation (ASV) and examined the effects of ASV combined with deep propofol sedation on PVI using a NavX.
  
  
  RESULTS
  We analysed 75 paroxysmal AF (PAF) patients (62 ± 11 years; 53 men and 22 women) who underwent PVI for treatment of PAF using an ASV system combined with deep sedation (ASV group). Control patients included 75 consecutive PAF patients (62 ± 11 years; 51 men and 24 women) who underwent PVI just before introduction of the ASV system. Deep sedation was defined as a Ramsay sedation score of 6. The ASV group had a lower frequency of restless body movements compared with the control group during PVI (1.5 ± 0.7 vs. 7.8 ± 1.4 times, P < 0.01). The frequency of respiratory compensation and EnGuide alignment of catheter position by the NavX was lower in the ASV (4.2 ± 3.3 and 8.8 ± 7.1 times) than control group (7.1 ± 5.1 and 15.2 ± 10.0 times, P < 0.05 and <0.01, respectively). Consequently, significantly lower total electrical energy supply (48.7 ± 6.0 KJ) was required in the ASV than control group (64.5 ± 24.9 KJ, P < 0.01). Further, significantly shorter fluoroscopy and procedural times were observed in the ASV (28 ± 5 and 109 ± 25 min) than the control group (33 ± 6 and 141 ± 38 min, respectively, P < 0.01) and the AF recurrence rate was significantly lower in the ASV than the control group (12 vs. 25%, P < 0.01).
  
  
  CONCLUSIONS
  ASV combined with deep sedation is an effective strategy during PVI using the NavX in patients with PAF.
authors: Okayama Heart Clinic, 54-1 Takeda, Naka-ku, Okayama, Japan.
authors: Takashi
authors: T
authors: Murakami
authors: Hirosuke
authors: H
authors: Yamaji
authors: Kenji
authors: K
authors: Numa
authors: Hiroshi
authors: H
authors: Kawamura
authors: Masaaki
authors: M
authors: Murakami
authors: Shunichi
authors: S
authors: Higashiya
authors: Shigeshi
authors: S
authors: Kamikawa
authors: Kazuyoshi
authors: K
authors: Hina
authors: Satoshi
authors: S
authors: Hirohata
authors: Shozo
authors: S
authors: Kusachi
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D054810:Deep Sedation / Q000009:adverse effects; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D059725:Interactive Ventilatory Support / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000009:adverse effects; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: Ablation; Atrial fibrillation; Ventilatory management