Implementation of NADS non-anesthesia deep sedation in the ablation suite for pulse field ablation procedures
T Mikkelsen, L Oerbech Petersen, M Prasad Skovmoeller, C Lundegaard AsfergAbstract
Background
In 2025, the Cardiology Laboratory in Roskilde introduced Pulse Field Ablation (PFA) for atrial fibrillation. PFA is safe and efficient, but requiring deep sedation. Increasing procedural volume and limited anesthesiology resources necessitated an alternative sedation model. International experience indicates that Non-Anesthesiologist-Administered Deep Sedation (NADS), delivered by specially trained nurses under structured protocols, can be performed safely.
Aim
To evaluate the feasibility and safety of NADS and its impact on workflow, recovery, and patient outcomes.
Methods
Nurse-led deep sedation was implemented using a Plan–Do–Study–Act framework in collaboration with the Department of Anesthesiology. A structured training program combined theoretical education, clinical guidelines, airway management training, simulation-based practice, and supervised bedside training. Competency was documented using assessment tools. Patient experiences were assessed through structured observations conducted from the time of return to the ward until discharge, during the period from September 2025 to February 2026. Procedure and recovery durations were estimated based on standard benchmarks for radiofrequency ablation and cryoablation, with the expected procedure duration set at 2 hours and the anticipated recovery duration at 4 hours. Data were analyzed using descriptive statistical methods, including frequency counts, proportions, and summary measures of procedure and recovery times.
Results
During the study period, a total of 85 procedures were performed. The findings demonstrated that all patients were clinically satisfied, with no recall of the procedure, no reported awareness, and no reported pain during PFA. Procedure time was reduced to 1 hour, corresponding to a 50% reduction, while the total time including recovery decreased by 25% (from 4-3 hours). No pain was reported during recovery, as assessed using the Visual Analog Scale. The initiative contributed to significant nursing competency development, and sedation regimens were continuously refined based on systematic evaluation.
Conclusion
NADS in the cardiology ablation suite appears to be feasible and safe when implemented with structured staff training and strong interdisciplinary collaboration. The model supports sedation delivery for the vast majority of eligible patients, while improving patient comfort and recovery profiles. In addition, the approach enhances procedural workflow efficiency and enables more effective allocation of anesthesiology resources to higher-complexity cases. These findings suggest that NADS can serve as a viable and resource-efficient sedation strategy in contemporary electrophysiology practice.