Impact of body weight on sedation-related outcomes in complex electrophysiological interventions
L Katov, C Dupree, Y Teumer, A Buss, F Diofano, C Bothner, W Oechsner, W Rottbauer, K Weinmann-EmhardtAbstract
Background
Higher body mass index (BMI) is associated with an increased prevalence of cardiometabolic comorbidities and anatomical risk factors that may elevate the risk of sedation-related complications. However, the impact of BMI on sedation safety during complex electrophysiological procedures (CEPs) remains uncertain.
Methods
In this study conducted at our University Heart Center, patients undergoing CEPs were stratified into three BMI groups: normal weight, overweight, and obesity. The primary composite endpoint (PCE) was the occurrence of sedation-related complications, defined as oxygen saturation below 90% combined with abnormal peripheral venous blood gas results—specifically, a venous carbon dioxide level exceeding 70 mmHg, an increase of more than 30% from baseline, or a pH drop below 7.25. Secondary endpoints included sedative and opioid requirements as well as occurrence of individual components of the PCE.
Results
A total of 726 patients were included, comprising 236 (32.5%) with normal weight, 265 (36.5%) overweight, and 225 (31.0%) obese. Patients with higher BMI presented with a greater burden of comorbidities and lower baseline oxygen saturation at the start of the procedure. While absolute sedative and opioid doses remained stable or even increased with BMI, relative doses (mg/kg) were higher in normal-weight patients. No significant differences were observed between BMI groups for either the primary or secondary endpoints. Female sex emerged as an independent predictor of adverse sedation events, with a higher incidence of reaching the PCE (p=0.046, OR 1.411).
Conclusions
BMI alone was not associated with an increased risk of sedation-related complications during CEPs. Despite higher absolute drug requirements and a greater comorbidity burden in overweight and obese patients, procedural safety was comparable across all BMI categories. These findings emphasize that individualized sedation protocols, embedded within standardized monitoring frameworks, are essential to ensure safe and effective sedation in diverse patient populations.