Deep sedation with dexmedetomidine administered by electrophysiologists
during COVID-19 pandemic compared with propofol administered by
anesthesiologists for transcatheter ablation of atrial fibrillation
Abstract
Background COVID-19 pandemic, limiting the availability of
anesthesiologists, has impacted heavily on the organization of invasive
cardiac procedures such as transcatheter atrial fibrillation (AF)
ablation. Objective We compared the safety and efficacy of deep sedation
with dexmedetomidine administered by electrophysiologists without
anesthesiologist supervision, against the standard protocol performed
with propofol. Methods We retrospectively included all AF ablation
procedures performed in 2020: 23 patients sedated with 1% propofol (2
ml bolus followed by infusion starting at 1 mg/Kg/h), 26 patients with
dexmedetomidine (infusion starting at 0.7 mcg/Kg/h). Both groups
additionally received 1 mcg/Kg of midazolam as a single bolus and 0.05
mg single boluses of fentanyl prior to ablation on each pair of
pulmonary veins (PV). Primary outcomes were oxygen desaturation
(<90%) or need for assisted ventilation/intubation,
bradycardia (heart rate <45 bpm) and persistent hypotension
(systolic blood pressure <90 mmHg). Results Baseline
characteristics and hemodynamic variables did not differ between the two
groups (all p>0.05). In 8/23 (35%) patients propofol
infusion velocity reduction was necessary to maintain the hemodynamic
values, compared to 7/26 (27%) with dexmedetomidine. Inter-group
comparison of hemodynamic variables during the procedure showed no
statistically significant difference, despite a trend in favor of
dexmedetomidine (3 respiratory depressions and 3 persistent hypotension
episodes with propofol vs. 0 with dexmedetomidine; p = 0.057).
Conclusion Deep sedation with dexmedetomidine administered by
electrophysiologists without anesthesiologist supervision is safe and
effective for AF transcatheter ablation. A trend towards a lower
incidence of hypotension and respiratory depression was noted when
compared to propofol.