Minimal and deep sedation during ablation of ventricular tachycardia

Abstract

Background: Catheter ablation is a curative treatment option for ventricular premature contractions (VPC) and ventricular tachycardia (VT). Procedures require different sedation levels, depending on duration, ablation approach and patient characteristics. The aim of our study was to evaluate feasibility of minimal and deep sedation for ablation of VPC/VT.

Methods: Patients underwent catheter ablation of VPC/VT under minimal or deep sedation. Events of hypotension, hypoxia, bradycardia, procedural complications and VT inducibility were compared between the groups.

Results: 120 patients were included. In 42 patients (53.6 ± 17.1 years, 47.6% male) ablation was performed under minimal sedation with midazolam, and in 78 patients (54.2 ± 17.5 years, 67.9% male) ablation was performed under deep sedation with propofol/midazolam. There were significantly fewer patients with idiopathic VT (62.8 vs. 88.1%, p=0.011) in the deep sedation group, LVEF was significantly lower (47 ± 14.4 vs. 53.1 ± 11.7) and the procedure duration was significantly longer (201.9 ± 85.9 vs. 137.9 ± 98.7). No significant differences in procedural complications or sedation related events (hypotension: 0 vs. 3.8%, p=0.2, no hypoxia, no bradycardia) were detected.

Conclusions: Minimal sedation and deep sedation are both feasible during VPC/VT ablation procedures. Propofol does not increase complications even in a collective with pre-existing impairment of LVEF. Adequate monitoring and trained personnel should be present.

Keywords: Ablation; Deep sedation; Minimal sedation; Ventricular tachycardia.