CONGRESS ABSTRACT

Aims: A standardized sedation protocol for pulsed-field ablation (PFA) of atrial fibrillation (AF) through irreversible cellular electroporation has not been well established. We report our experience of a protocol for deep sedation with propofol maintaining spontaneous respiration during the PFA of AF. Bispectral index Monitoring System (BIS) is a technologies used to monitor depth of anesthesia and to maintain a targeted sedation range . Methods and results: All consecutive patients undergoing PFA for AF at our center were included. Our sedation protocol involves the intravenous administration of fentanyl (1 mcg/kg) and midazolam (2 mg) at low doses before local anesthesia with lidocaine. A propofol infusion (1 mg/kg/h) was injected about 5 minutes before the first PFA delivery and suspended at the end of the procedure . We enrolled 52 patients (age = 54 +- 9 years, 72,6 % males, body mass index = 26.7+- 5 kg/m2, fluoroscopy time = 21[15–30] min, skin-to-skin time = 70 [60–100] min and PFA LA dwell time = 25[22–28] min). By the end of the procedure, PVI had been achieved in all patients by means of PFA alone. The mean time under sedation was 48.4 -+ 6 min, with 8 (4%) patients being sedated for more than 1 hour. A satisfactory Ramsey Sedation Scale level during propofol infusion was achieved in all patients except one (84.1% of the patients with rank 3; 15.9 % with rank 2). In all procedures, the satisfaction level was found to be acceptable by both the patient and the primary operator (Score = 0 in 99.4% of cases). All patients reported none or mild pain. No major procedure or anesthesia-related complications were reported. Conclusion: Our standardized anesthesia protocol with the administration of drugs in association with Bispectral Index Monitoring System to maintain a targeted sedation range during pulsed-field ablation of atrial fibrillation was safe and effective, with an optimal degree of patient and operator satisfaction.