title: Simple minimal sedation for catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  Deep sedation or general anesthesia is generally used during atrial fibrillation (AF) ablation. The aim of this study was to report the safety and feasibility of minimal sedation during AF ablation.
  
  
  RESULTS
  One thousand and fifty-two AF ablation procedures in 819 patients (62 ± 11 years, 621 men, 506 paroxysmal) were included. Boluses of intravenous hydroxyzine pamoate and pentazocine were administered, with a maximal dose of 100 mg of hydroxyzine and 60 mg of pentazocine in response to pain. If the pain was intolerable or patients requested deeper sedation, moderate sedation using dexmedetomidine or propofol was introduced. Among 819 consecutive first procedures, the procedure was completed under minimal sedation in 795 (97.1%) patients without inotropic drugs or respiratory support, whereas in 20 (2.4%) patients, anesthesia was switched to moderate sedation due to pain. Patients requiring a switch to moderate sedation were significantly younger than those without (53.6 ± 2.3 vs. 62.6 ± 10.4, P<0.01). No procedures were abandoned due to adverse effects of sedation. Significant intra-procedural blood pressure decreases requiring inotropic drugs were not observed in any patients. Among 233 patients who underwent repeat procedures, 6 (2.6%) requested moderate sedation before the procedure. The mean procedure time was 151 ± 54 min. Cardiac tamponade, unrelated to sedation, was observed in 7 (0.66%) procedures.
  
  
  CONCLUSIONS
  Minimal sedation might be acceptable anesthesia in the vast majority of AF ablation procedures performed in electrophysiological laboratories.
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Ichihara
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Eisuke
authors.initials: E
authors.lastname: Usui
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Takagi
authors.forename: Jin
authors.initials: J
authors.lastname: Iwasawa
authors.forename: Akio
authors.initials: A
authors.lastname: Kuroi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010423:Pentazocine / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D006919:Hydroxyzine; D010423:Pentazocine