Electrophysiology Team–Administered Conscious Sedation for Pulsed‐Field Versus Radiofrequency Ablation in Atrial Fibrillation
Li Cheng, Yu Xia, Zhicheng Hu, Tao Zhang, Le Li, Xu Meng, Yulong Xiong, Qin Xu, Zhenhao Zhang, Guanzhi Chen, Ligang Ding, Yan YaoBackground
Pulsed‐field ablation (PFA) is emerging as a novel nonthermal alternative. However, PFA is commonly performed under general anesthesia or deep sedation requiring anesthesiologists, which increases resource utilization and limits its widespread application. This study aimed to evaluate the feasibility of conscious sedation for PFA administered by the electrophysiology (EP) team, using radiofrequency ablation (RFA) as a comparator.
Methods
A total of 120 patients with symptomatic, drug‐refractory atrial fibrillation were randomized in a 1:1 ratio to the PFA group or the RFA group. We evaluated three key outcomes: (1) intraoperative patient tolerance, assessed using validated scales (Faces Pain Scale‐Revised [FPS‐R], Likert Scale Questionnaire [LSQ]) combined with intraoperative body movement and cough reactions; (2) procedural efficiency; and (3) procedural safety.
Results
The incidence of pain during pulmonary vein isolation was comparable between the two groups (all p > 0.05), whereas FPS‐R scores were significantly lower in the PFA group ( p < 0.05). No significant difference was observed in movement scores between the two groups ( p = 0.452). According to the LSQ analysis, only 1 patient (1.7%) in the RFA group reported dissatisfaction with intraoperative pain management. Cough incidence during PVI was higher with PFA (21.7% [13/60] vs 6.7% [4/60]; p = 0.018). Both total procedure time and left atrial dwell time were shorter in the PFA group. Furthermore, no serious complications were directly related to conscious sedation.
Conclusion
In selected low‐risk patients, EP team–administered conscious sedation is feasible for PFA, with acceptable intraoperative tolerance and safety while preserving procedural efficiency.