title: Propofol sedation administered by cardiologists for patients undergoing catheter ablation for ventricular tachycardia.
abstract: OBJECTIVE
  Propofol sedation has been shown to be safe for atrial fibrillation ablation and internal cardioverter-defibrillator implantation but its use for catheter ablation (CA) of ventricular tachycardia (VT) has yet to be evaluated. Here, we tested the hypothesis that VT ablation can be performed using propofol sedation administered by trained nurses under a cardiologist's supervision.
  
  
  RESULTS
  Data of 205 procedures (157 patients, 1.3 procedures/patient) undergoing CA for sustained VT under propofol sedation were analysed. The primary endpoint was change of sedation and/or discontinuation of propofol sedation due to side effects and/or haemodynamic instability. Propofol cessation was necessary in 24 of 205 procedures. These procedures (Group A; n = 24, 11.7%) were compared with those with continued propofol sedation (Group B; n = 181, 88.3%). Propofol sedation was discontinued due to hypotension (n = 22; 10.7%), insufficient oxygenation (n = 1, 0.5%), or hypersalivation (n = 1, 0.5%). Procedures in Group A were significantly longer (210 [180-260] vs. 180 [125-220] min, P = 0.005), had a lower per hour propofol rate (3.0 ± 1.2 vs. 3.8 ± 1.2 mg/kg of body weight/h, P = 0.004), and higher cumulative dose of fentanyl administered (0.15 [0.13-0.25] vs. 0.1 [0.05-0.13] mg, P < 0.001), compared with patients in Group B. Five (2.4%) adverse events occurred.
  
  
  CONCLUSIONS
  Sedation using propofol can be safely performed for VT ablation under the supervision of cardiologists. Close haemodynamic monitoring is required, especially in elderly patients and during lengthy procedures, which carrying a higher risk for systolic blood pressure decline.
authors.affiliation: Department for Cardiac Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany helge.servatius@insel.ch.
authors.forename: Helge
authors.initials: H
authors.lastname: Servatius
authors.affiliation: Department for Cardiac Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Thormen
authors.initials: T
authors.lastname: Höfeler
authors.affiliation: Department for Cardiac Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Boris A
authors.initials: BA
authors.lastname: Hoffmann
authors.affiliation: Department for Cardiac Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Arian
authors.initials: A
authors.lastname: Sultan
authors.affiliation: Department for Cardiac Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Lüker
authors.affiliation: Department for Cardiac Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schäffer
authors.affiliation: Department for Cardiac Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.affiliation: Department for Cardiac Electrophysiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D000072096:Cardiologists; D017115:Catheter Ablation / Q000379:methods*; D017147:Defibrillators, Implantable; D005260:Female; D005858:Germany; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D017180:Tachycardia, Ventricular / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol
keywords: Adverse events; Catheter ablation; Propofol; Sedation; Ventricular tachycardia