Sedation strategies for pulsed-field ablation of atrial fibrillation with monitored anesthesia care versus general anesthesia: a single-center experience

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial Fibrillation (AF) ablation has been performed successfully under different methods anesthesia and varies between centers, from general anaesthesia (GA) to conscious sedation. Recently, a novel pulsed-field (PFA, Farapulse) technology based on non-thermal become available for clinical use. To date, no structured sedation strategy implemented this specific energy source. Purpose We sought compare GA protocol monitored care (MAC) used at high-volume center, with special consideration efficiency optimization mapping conditions. Methods All consecutive patients (pts) undergoing AF PFA our center were included. Briefly, was delivered by protocol-directed PVI using 2kV eight applications per vein, that is, four each in the basket flower poses. The choice anesthesia’s depends preference experience operator conditions patient. MAC includes propofol as only anesthetic agent analgesia fentanyl. include sevofluorane agents fentanyl remifentanyl analgesia. Anesthesia related complications (hypotension hemodinamic instability, respiratory complications, postoperative nausea vomit) operative pain, chest movements, patient satisfaction have reported. Data are reported mean±DS. Results Thirty-six pts included analysis, 28 (78%) indicated paroxysmal 8 (22%) persistent AF. applied 16 (44%) procedures 30 (56%) procedures. No differences found terms procedural management parameters according these two strategies, is vs GA: 114±28min 121±19min lab occupancy time, p=0.3521; 66±14min 81±25min total support p=0.0683; 63±9min 63±18min skin-to-skin p=0.3887; 19±6min 20±5min fluoroscopy p=0.3313, respectively). major procedure-related adverse events Operative pain movements less protocol, greater protocol. significant post-operative vomit found. Conclusion adoption workflow proper perioperative assessment during AF, both showed similar efficacy safety profile.