The Practice of Deep Sedation in Electrophysiology and Cardiac Pacing Laboratories: Results of an Italian Survey Promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Pietro Palmisano¹, Matteo Ziacchi², Andrea Angeletti², Federico Guerra³, Giovanni Battista Forleo⁴, Matteo Bertini⁵, Pasquale Notarstefano⁶, Michele Accogli¹, Carlo Lavalle⁷, Giovanni Bisignani⁸, Maurizio Landolina⁹, Gabriele Zanotto¹⁰, Antonio D'Onofrio¹¹, Renato Pietro Ricci¹², Roberto De Ponti¹³, Giuseppe Boriani¹⁴

Affiliations

¹ Cardiology Unit, "Card. G. Panico" Hospital, 73039 Tricase, Italy.
² Institute of Cardiology, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy.
³ Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, 60126 Ancona, Italy.
⁴ Department of Cardiology, Ospedale Luigi Sacco, 20157 Milano, Italy.
⁵ Cardiology Unit, Azienda Ospedaliero-Universitaria Di Ferrara "Arcispedale S. Anna", 44124 Cona, Ferrara, Italy.
⁶ Cardiovascular Department, San Donato Hospital, 52100 Arezzo, Italy.
⁷ Department of Cardiology, Policlinico Universitario Umberto I, 00161 Roma, Italy.
⁸ Cardiology Division, Castrovillari Hospital, ASP Cosenza, 87012 Castrovillari, Italy.
⁹ Cardiology Department, Ospedale Maggiore Di Crema, 26013 Crema, Italy.
¹⁰ Department of Cardiology, Mater Salutis Hospital, 37045 Legnago, Verona, Italy.
¹¹ Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, 80131 Naples, Italy.
¹² Centro Cardio-Aritmologico, 00152 Roma, Italy.
¹³ Department of Heart and Vessels, Ospedale Di Circolo-University of Insubria, 21100 Varese, Italy.
¹⁴ Department of Biomedical, Metabolic and Neural Sciences, Cardiology Division, University of Modena and Reggio Emilia, Policlinico Di Modena, 41121 Modena, Italy.

PMID: 34768557
PMCID: PMC8584354
DOI: 10.3390/jcm10215035

The Practice of Deep Sedation in Electrophysiology and Cardiac Pacing Laboratories: Results of an Italian Survey Promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Pietro Palmisano et al. J Clin Med. 2021.

. 2021 Oct 28;10(21):5035.

doi: 10.3390/jcm10215035.

Authors

Affiliations

¹ Cardiology Unit, "Card. G. Panico" Hospital, 73039 Tricase, Italy.
² Institute of Cardiology, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy.
³ Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, 60126 Ancona, Italy.
⁴ Department of Cardiology, Ospedale Luigi Sacco, 20157 Milano, Italy.
⁵ Cardiology Unit, Azienda Ospedaliero-Universitaria Di Ferrara "Arcispedale S. Anna", 44124 Cona, Ferrara, Italy.
⁶ Cardiovascular Department, San Donato Hospital, 52100 Arezzo, Italy.
⁷ Department of Cardiology, Policlinico Universitario Umberto I, 00161 Roma, Italy.
⁸ Cardiology Division, Castrovillari Hospital, ASP Cosenza, 87012 Castrovillari, Italy.
⁹ Cardiology Department, Ospedale Maggiore Di Crema, 26013 Crema, Italy.
¹⁰ Department of Cardiology, Mater Salutis Hospital, 37045 Legnago, Verona, Italy.
¹¹ Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, 80131 Naples, Italy.
¹² Centro Cardio-Aritmologico, 00152 Roma, Italy.
¹³ Department of Heart and Vessels, Ospedale Di Circolo-University of Insubria, 21100 Varese, Italy.
¹⁴ Department of Biomedical, Metabolic and Neural Sciences, Cardiology Division, University of Modena and Reggio Emilia, Policlinico Di Modena, 41121 Modena, Italy.

PMID: 34768557
PMCID: PMC8584354
DOI: 10.3390/jcm10215035

Abstract

The aim of this survey, which was open to all Italian cardiologists involved in arrhythmia, was to assess common practice regarding sedation and analgesia in interventional electrophysiology procedures in Italy. The survey consisted of 28 questions regarding the approach to sedation used for elective direct-current cardioversion (DCC), subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation, atrial fibrillation (AF) ablation, ventricular tachycardia (VT) ablation, and transvenous lead extraction procedures. A total of 105 cardiologists from 92 Italian centres took part in the survey. The rate of centres where DCC, S-ICD implantation, AF ablation, VT ablation and lead extraction procedures were performed without anaesthesiologic assistance was 60.9%, 23.6%, 51.2%, 37.3%, and 66.7%, respectively. When these procedures were performed without anaesthesiologic assistance, the drugs (in addition to local anaesthetics) commonly administered were benzodiazepines (from 64.3% to 79.6%), opioids (from 74.4% to 88.1%), and general anaesthetics (from 7.1% to 30.4%). Twenty-three (21.9%) of the 105 cardiologists declared that they routinely administered propofol, without the supervision of an anaesthesiologist, in at least one of the above-mentioned procedures. In current Italian clinical practice, there is a lack of uniformity in the sedation/analgesia approach used in interventional electrophysiology procedures.

Keywords: ablation; cardioversion; electrophysiology; implantable cardioverter defibrillator; pacemaker; sedation.

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Conflict of interest statement

G.B., Giuseppe Boriani, reported no conflicts with regard to the content of the present work; outside this work small speaker fees from Bayer, Boehringer Ingelheim, Boston and Medtronic and Novartis; P.P.: no conflicts with regard to the content of the present work; outside this work small speaker fees from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Medtronic and Novartis; R.P.R. reported no conflicts with regard to the content of the present work; outside this work small consultancy fees by Abbott, Boston, Dompé; R.D.P. reported no conflicts with regard to the content of the present work; outside this work has received honoraria for lectures and scientific collaboration from Biosense Webster-Johnson and Johnson Medical. No other conflicts of interest were reported.

Figures

**Figure 1**
(**Panel A**): Geographic distribution of the centres that responded to the survey across Italy. (**Panel B**): Number of beds in the hospitals where the participating centres were located. (**Panel C**): Rate of centres where the electrophysiological procedures analysed were performed. Abbreviations used in the figure. AF: atrial fibrillation; DCC: direct-current cardioversion; S-ICD: subcutaneous implantable cardioverter-defibrillator; VT: ventricular tachycardia.

**Figure 2**
(**Panel A**): Elective direct-current cardioversion procedure volumes of participating centres. (**Panel B**): Anaesthesia/analgesia approach used for the procedure. Abbreviations used in the figure. DCC: direct-current cardioversion; EP lab: electrophysiology laboratory.

**Figure 3**
(**Panel A**): Subcutaneous implantable cardioverter-defibrillator implantation volume of participating centres. (**Panel B**): Anaesthesia/analgesia approach used for the procedure. Abbreviations used in the figure. S-ICD: subcutaneous implantable cardioverter-defibrillator; EP lab: electrophysiology laboratory.

**Figure 4**
(**Panel A**): Atrial fibrillation ablation procedure volumes of participating centres. (**Panel B**): Anaesthesia/analgesia approach used for the procedure. Abbreviations used in the figure. AF: atrial fibrillation; EP lab: electrophysiology laboratory.

**Figure 5**
(**Panel A**): Ventricular tachycardia ablation procedure volumes of participating centres. (**Panel B**): Anaesthesia/analgesia approach used for the procedure. Abbreviations used in the figure. VT: ventricular tachycardia; EP lab: electrophysiology laboratory.

**Figure 6**
Anaesthesia/analgesia approach used for transvenous lead extraction procedures. Abbreviations used in the figure. EP lab: electrophysiology laboratory.

See this image and copyright information in PMC

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The Practice of Deep Sedation in Electrophysiology and Cardiac Pacing Laboratories: Results of an Italian Survey Promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Affiliations

The Practice of Deep Sedation in Electrophysiology and Cardiac Pacing Laboratories: Results of an Italian Survey Promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Authors

Affiliations

Abstract

Conflict of interest statement

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