The Effectiveness and Safety of Deep Sedation Protocols for Pulsed Field Ablation of Atrial Fibrillation
Yize Zhao, Fadong Li, Jue Wang, Le Zhou, Xiangyi Kong, Shaobin Wei, Mengge Zhou, Han Feng, Zhicong Wang, Yueqing Mu, Jinghe Xue, Bo Wen, Yanyan Jiang, Liu He, Chao Jiang, Shijun Xia, Xiaoxia Liu, Xueyuan Guo, Ning Zhou, Songnan Li, Chenxi Jiang, Ribo Tang, Caihua Sang, Deyong Long, Xin Du, Song Zuo, Jianzeng Dong, Changsheng MaABSTRACT
Background
Deep sedation (DS) is increasingly utilized during pulsed field ablation (PFA) for atrial fibrillation (AF), but the optimal electrophysiologist‐led sedation regimen remains unclear.
Objective
To compare sedative effectiveness and safety of three electrophysiologist‐led DS protocols.
Methods
In this prospective, single‐center study, AF patients undergoing focal‐form PFA received (1) midazolam + fentanyl (Midazolam group), (2) flurbiprofen axetil + midazolam + fentanyl (Flurbiprofen group), or (3) dexmedetomidine + fentanyl (Dexmedetomidine group). The primary endpoint was the achievement of the target sedation level at ablation initiation (Ramsay Sedation Score ≥3). Secondary endpoints included intraoperative pain, sedation difficulty, operator satisfaction, and sedation‐related adverse events.
Results
166 patients (mean age, 62.2 ± 10.8 years; 62.7% male; 48.2% with paroxysmal AF) were enrolled, with 53, 67, and 46 patients included in the Midazolam, Flurbiprofen, and Dexmedetomidine groups, respectively. The primary outcome occurred more frequently in the Flurbiprofen (73.1%) and Dexmedetomidine (82.6%) groups compared to Midazolam (47.2%) (overall p < 0.001); Flurbiprofen and Dexmedetomidine group did not differ significantly. Intraoperative pain scores were lowest with Dexmedetomidine (overall p < 0.001). Both Flurbiprofen and Dexmedetomidine groups showed lower sedation difficulty and higher operator satisfaction than the Midazolam group (both overall p < 0.001). Dexmedetomidine was associated with more intraoperative hypotension (overall p = 0.047).
Conclusion
Electrophysiologist‐led DS protocols with Flurbiprofen and Dexmedetomidine were associated with higher target sedation attainment than the specific low‐dose Midazolam regimen during PFA, but Dexmedetomidine is linked to higher hypotension rates, warranting caution.