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MINERVA CARDIOANGIOLOGICA

A Journal on Heart and Vascular Diseases


Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2017 Oct 25

DOI: 10.23736/S0026-4725.17.04505-4

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Conscious sedation during cryoballoon ablation of atrial fibrillation: the feasibility and safety study

Dawid MIŚKOWIEC , Jarosław D. KASPRZAK, Paulina WEJNER-MIK, Ewa SZYMCZYK, Haval D. QAWOQ, Paweł ŻYCIŃSKI, Tomasz WCISŁO, Piotr PAGÓREK, Karolina KUPCZYŃSKA, Piotr LIPIEC

Department of Cardiology, Medical University of Lodz, Lodz, Poland


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BACKGROUND: Cryoballoon ablation for atrial fibrillation (cryoAF) is relatively simple, cost-effective and easy procedure. However, general anesthesia during this procedure may have negative impact on patients mortality and morbidity, as well as procedure costs.
AIM: We sought to assess the feasibility and safety of conscious sedation during cryoAF.
METHODS: Patients (pts) with paroxysmal or persistent, drug-refractory AF who underwent a first procedure of cryoAF were included in our single-center, retrospective study. The loading dose of midazolam was 2mg and loading fentanyl dose was 25mcg intravenously. Additional doses of midazolam and fentanyl were administered, if necessary. Midazolam and fentanyl were administered to maintain amnesia and analgesia, and pts’s responsiveness in Ramsay Sedation Score was assessed every 10 minutes with sedation kept at the Ramsey Sedation Scale not exceeding Ramsey 3 Grade.
RESULTS: 71 pts with mean age 59.5±11.1 years were enrolled (48 males, 68%). The TEE and the TEEguided transseptal puncture was feasible in all pts. The mean duration of cryoAF procedure was 136.3±36.0 minutes. The overall mean midazolam and fentanyl used doses were: 5.1±3.1mg (55.7±35.1mcg/kg) and 98.9±51.1 mcg (1.13±0.60mcg/kg). In 3 pts (4.2%) vascular complications occurred (femoral vein bleeding with hematoma formation without communication with femoral artery). In 1 case (1.4%) transient right phrenic palsy was observed - symptoms have disappeared completely within 12h after procedure. The overall acute procedural success rate of cryoAF (defined as electrical isolation of all pulmonary veins) was 68/71 (95.8%).
CONCLUSIONS: Conscious sedation is a safe, efficacious and feasible during cryoablation of pulmonary veins for AF.


KEY WORDS: Atrial fibrillation - Cryoballoon ablation - Conscious sedation - Safety - Feasibility - Transesophageal echocardiography

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Publication History

Article first published online: October 25, 2017
Manuscript accepted: October 24, 2017
Manuscript received: August 17, 2017

Cite this article as

Miśkowiec D, Kasprzak JD, Wejner-Mik P, Szymczyk E, Qawoq HD, Życiński P et al. Conscious sedation during cryoballoon ablation of atrial fibrillation: the feasibility and safety study. Minerva Cardioangiol 2017 Oct 25. DOI: 10.23736/S0026-4725.17.04505-4

Corresponding author e-mail

dawid.miskowiec@gmail.com