Optimizing the sedation approach. Expanding frontiers with Affera
S Huelamo Montoro, N Fernandez Ortiz, C Arveras Martinez, J Navarrete Navarro, J Navarro Manchon, O Cano Perez, M Izquierdo De Francisco, J Llau Garcia, E Robles Perez, L Martinez Dolz, J Osca AsensiAbstract
Background
Atrial fibrillation (AF) ablation is the most effective treatment for rhythm control in AF patients. This procedure can be performed under general anesthesia (GA) or under local anesthesia with deep sedation (DS). Although GA is the most commonly used anesthetic approach in patients undergoing AF ablation, DS is mainly used in Europe. Currently, there are no established guidelines regarding the selection of anesthesia for AF ablation. Affera-based ablation has been performed in GA, and there is little experience for procedures in DS.
Purpose
The aim of this study was to analyze the outcomes of Affera-based ablations performed under DS and to compare procedure times between cases performed under DS and those performed under GA.
Methods
Patients referred for Affera-based ablation since March 2025 were consecutively recruited. Overall procedure times, as well as times according to the type of arrhythmia ablated, were analyzed and compared between cases performed under DS and those performed under GA. The initial procedural success rates and the number of complications in procedures performed under DS were also analyzed. DS was performed using fentanyl (25+25 µg), 2mg midazolam and propofol 1% (infusion adapted at 40-60ml/h with optional boluses).
Results
We performed 90 Affera-based ablation procedures since March 2025 (38 cases of atrial flutter, 27 of AF, 22 of ventricular tachycardia and 3 of supraventricular tachycardia). 87% of these procedures were performed under DS and 13% with GA. Global procedure time was 88±47 minutes with GA and 79±37 minutes with DS (p=0,2). When we analyzed the procedure times according to the type of arrhythmia, these were 78±58 minutes with GA and 70±40 with DS for atrial flutter (p=0,5), 82±58 minutes with GA and 70±40 with DS for AF (p=0,1) and 97±58 minutes with GA and 100±45 with DS for ventricular tachycardia (p=0,5). From our experience, acute ablation objective was accomplished in 100%, it was need to repeat electroanatomical mapping in only 1 case for movement, it was possible to perform Affera cases with DS even for the most complex cases and it was not observed any procedure
complication.
Conclusion
DS is a safe and effective alternative to GA for Affera-based ablation, providing similar procedural times and outcomes without increasing complication rates.