• Hans Kottkamp, Gerhard Hindricks, Charlotte Eitel, Kristin Müller, Angela Siedziako, Julia Koch, Maria Anastasiou-Nana, Christos Varounis, Arash Arya, Philipp Sommer, Thomas Gaspar, Christopher Piorkowski, and Nikolaos Dagres.
• Department of Electrophysiology, Clinic Hirslanden, Zurich, Switzerland. hans.kottkamp@hirslanden.ch
• J. Cardiovasc. Electrophysiol. 2011 Dec 1;22(12):1339-43.

IntroductionCatheter ablation of atrial fibrillation (AF) is a highly invasive and relatively long-lasting procedure with specific requirements for patient sedation. The feasibility and safety of deep sedation is described in a prospective study of 650 consecutive patients.MethodsSedation was initiated with an intravenous (iv) bolus of midazolam, and analgesia with an iv fentanyl bolus. After an iv propofol bolus, maintenance of sedation was achieved with continuous iv administration of propofol with a guide dose of 5 mg per kg per hour. Heart rate, invasive arterial blood pressure, and oxygenation were continuously monitored. The administration of sedation and analgesia medication were performed by a nurse under the supervision and instructions of the electrophysiologist.ResultsThe mean dose of the initial midazolam bolus was 2.4 ± 0.7 mg and of the initial propofol bolus 32 ± 11 mg. The beginning dose of continuous propofol infusion was 352 ± 66 mg/h; titration to the desired effect of deep sedation required adjustment on an average of 3.8 ± 2.6 times leading to a maintenance dose of continuous propofol infusion of 399 ± 99 mg/h. No major sedation-related complications were observed. Endotracheal intubation was necessary in none of the patients. Heart rate, invasive arterial blood pressure, and oxygenation remained stable during sedation.ConclusionDeep sedation for catheter ablation of AF is feasible and safe. Especially, the goal of keeping the patient in deep sedation while maintaining spontaneous ventilation and cardiovascular hemodynamic stability was accomplished. Endotracheal intubation or consultation of an anesthesiologist was not necessary in any patient.© 2011 Wiley Periodicals, Inc.

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