670 DEXMEDETOMIDINE SEDATION FOR PULMONARY VEIN ISOLATION PROCEDURE

Abstract Background Peri-procedural anesthesia for catheter ablation of atrial fibrillation (AF) varies from conscious sedation to general anesthesia. Current guidelines do not suggest any specific strategy, thus the choice between different protocols is mainly driven by local expertise, operator and/or patient preference and availability a dedicated anesthesiology team. Propofol often drug despite risk respiratory depression. Few data have recently reported operator-directed nurse-administered dexmedetomidine (DEX) as an effective safe strategy. Aim study To evaluate outcomes DEX in AF (pulmonary vein isolation-PVI). Method Between May 2022 August 2022, 41 consecutive patients (male 83%, median age 64 years, IQR 57-71) with drug-refractory paroxysmal (n.27;66%) or persistent (n.14;34%) underwent first PVI procedure under sedation. Our protocol consisted continuous intravenous administration (0.2–0,7 µg/kg/hr) titrated throughout achieve mild moderate (Modified Observer's Assessment Alertness Sedation Scale 2-3). A single dose Ondansetron (4 mg) was administered beginning procedure. Adjunctive doses fentanyl (cumulative 50-100 µg) were before radiofrequency (RF) delivery case inadequate control pain. low propofol bolus (<1mg/kg) eventually added electrical cardioversion (ECV). Sedation-related complications evaluated, including sustained hypoxemia (SpO2 <90%), need anesthesiologist support hypotension (SBP < 90 mmHg). The day after procedure, patients’ satisfaction pain (0-100 scale) assessed standardized questionnaire. Results Pulmonary isolation performed either Low Power Long Duration (LPLD, n.17;41,46%) High-Power Short (HPSD, n.24;58,54%) RF protocol. Median time 135’ (IQR 110-170’). 0,30 µg/kg/hr 0,27-0,33 µg/kg/hr). 75 µg µg). In needing ECV (n. 16; 39%), 60 mg 47,5–105 mg). Thirteen (31,7%) had one more significant factor (obesity, severe heart failure, pulmonary comorbidity, coronary artery disease) anesthesia-related complications. scale value 20 10-50). Majority (90,2%, n.37) (pain <60/100) during overall high (median 90, 80-100), 90,2% declaring 60/100 more. These results independent baseline characteristics (sex, age, type, HF, CAD, obesity) procedural aspects (LPLD vs HPSD, time, ECV). strong linear correlation found (r=-0,59). Only 1 (2,4%) sedation-related complication occurred, consisting post treated volume repletion. Conclusions our experience, associated no It seems be also feasible at higher (severe BMI > 30 kg/m2), generally excluded previous studies.