Minimal and deep sedation during ablation of ventricular tachycardia.
BACKGROUND
Catheter ablation is a curative treatment option for ventricular premature contractions (VPC) and ventricular tachycardia (VT). Procedures require different sedation levels, depending on duration, ablation approach and patient characteristics. The aim of our study was to evaluate feasibility of minimal and deep sedation for ablation of VPC/VT.


METHODS
Patients underwent catheter ablation of VPC/VT under minimal or deep sedation. Events of hypotension, hypoxia, bradycardia, procedural complications and VT inducibility were compared between the groups.


RESULTS
120 patients were included. In 42 patients (53.6 ± 17.1 years, 47.6% male) ablation was performed under minimal sedation with midazolam, and in 78 patients (54.2 ± 17.5 years, 67.9% male) ablation was performed under deep sedation with propofol/midazolam. There were significantly fewer patients with idiopathic VT (62.8 vs. 88.1%, p=0.011) in the deep sedation group, LVEF was significantly lower (47 ± 14.4 vs. 53.1 ± 11.7) and the procedure duration was significantly longer (201.9 ± 85.9 vs. 137.9 ± 98.7). No significant differences in procedural complications or sedation related events (hypotension: 0 vs. 3.8%, p=0.2, no hypoxia, no bradycardia) were detected.


CONCLUSIONS
Minimal sedation and deep sedation are both feasible during VPC/VT ablation procedures. Propofol does not increase complications even in a collective with pre-existing impairment of LVEF. Adequate monitoring and trained personnel should be present.
Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany. Electronic address: alexander.wutzler@charite.de.
Alexander
A
Wutzler
Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Amélie
A
Mueller
Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Lena
L
Loehr
Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Martin
M
Huemer
Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Abdul Shokor
AS
Parwani
Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Philipp
P
Attanasio
Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Florian
F
Blaschke
Department of Intensive Care Medicine, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Christian
C
Storm
Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Leif-Hendrik
LH
Boldt
Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Wilhelm
W
Haverkamp
D000138:Acidosis / Q000139:chemically induced; D000328:Adult; D000368:Aged; D001919:Bradycardia / Q000139:chemically induced; D017115:Catheter Ablation / Q000379:methods*; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods; D054810:Deep Sedation / Q000009:adverse effects* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007022:Hypotension / Q000139:chemically induced; D000860:Hypoxia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D011724:Pyridazines / Q000008:administration & dosage / Q000009:adverse effects; D017180:Tachycardia, Ventricular / Q000601:surgery*; D018879:Ventricular Premature Complexes / Q000601:surgery*
D006993:Hypnotics and Sedatives; D011724:Pyridazines; C048087:medazomide; D015742:Propofol
Ablation; Deep sedation; Minimal sedation; Ventricular tachycardia