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. 2023 Jul 26;12(15):4900.
doi: 10.3390/jcm12154900.

Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis

Matthias Bock  1   2 , Matthew O'Connor  3 , Amir Chouchane  1 , Philip Schmidt  1 , Claudia Schaarschmidt  1 , Katharina Knoll  1   2 , Fabian Bahlke  1 , Florian Englert  1 , Theresa Storz  1 , Marc Kottmaier  1 , Teresa Trenkwalder  1 , Tilko Reents  1 , Felix Bourier  1 , Marta Telishevska  1 , Sarah Lengauer  1 , Gabriele Hessling  1 , Isabel Deisenhofer  1 , Christof Kolb  1 , Carsten Lennerz  1   2
Affiliations

Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis

Matthias Bock et al. J Clin Med. .

Abstract

Background: The demand for transvenous lead extraction (TLE) has increased. In line with this, the safety of such procedures has also increased. Traditionally, TLE is performed under resource-intensive general anaesthesia. This study aims to evaluate the safety and outcomes of Cardiologist-lead deep sedation for TLE.

Methods: We retrospectively analysed 328 TLE procedures performed under deep sedation from 2016 to 2019. TLE procedures were performed by experienced electrophysiologists. Sedation was administered by a specifically trained cardiologist (bolus midazolam/fentanyl and propofol infusion). Procedural sedation data including blood pressure, medication administration and sedation time were collected. Complications related to sedation and the operative component of the procedure were analysed retrospectively.

Results: The sedation-associated complication rate during TLE was 22.0%. The most common complication (75% of complications) was hypotension requiring noradrenaline, followed by bradycardia requiring atropine (13% of complications). Additionally, the unplanned presence of an anaesthesiologist was needed in one case (0.3%). Deep sedation was achieved with midazolam (mean dose 42.9 ± 26.5 µg/kg), fentanyl (mean dose 0.4 ± 0.6 µg/kg) and propofol (mean dose 3.5 ± 1.2 mg/kg/h). There was no difference in medication dosage between those with a sedation-associated complication and those without. Sedation-associated complications appeared significantly more in patients with reduced LVEF (p = 0.01), renal impairment (p = 0.01) and a higher American Society of Anaesthesiologists (ASA) class (p = 0.01).

Conclusion: Deep sedation for TLE can be safely performed by a specifically trained cardiologist, with a transition to general anaesthesia required in only 0.3% of cases. We continue to recommend the on-call availability of an anaesthesiologist and cardiac surgeon in case of major complications.

Keywords: cardiac implantable electronic devices; cardiologist-directed deep sedation; deep sedation; lead revision; transvenous lead extraction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Correlations of the propofol dosage with age (a), BMI (b), kidney function (GFR) (c) and heart function (LV-EF) (d). The propofol correlated with heart (LV-EF) and kidney function (GFR) and correlated inversely with age and BMI of the patients.
Figure 2
Figure 2
Distribution of sedation-associated complications during TLE. A total of 78% of patients did not suffer any complications. Within complications, the most common complication was hypotension requiring noradrenaline (75%), followed by bradycardia requiring atropine (13%) and conservatively treated hypotension (8%).
See this image and copyright information in PMC

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