Sedation in the Electrophysiology Laboratory: A Multidisciplinary Review

A pproaches to sedation in the electrophysiology (EP) laboratory range from intravenous sedation techniques to general anesthesia (GA) (Table 1). Although the provision of GA requires a dedicated anesthesia provider, controversy exists as to whether intravenous sedation in this complex patient population can or should be undertaken by a proceduralist-directed nurse-administered (PDNA) model. In a recent survey of 38 national academic centers, electrophysiologists noted that in 26.3% of EP cases, an anesthesiologist is warranted most of the time or always due to patient complexity, yet there is also ample literature espousing the safety and benefits of PDNA sedation for these cases. Moreover, intended sedation plans may require modification over the course of a procedure. A 2-year review of 208 adults undergoing catheter ablation (including for supraventricular tachycardia, atrial tachycardia, atrial flutter, premature ventricular contraction, and ventricular tachycardia) using a variety of sedation strategies demonstrated that of the 186 non-GA cases, 20 required conversion to GA and 54 needed additional airway interventions. This article provides a comprehensive interdisciplinary review of sedation practices for EP procedures. It examines different care models (dedicated anesthesiology team, ad hoc anesthesiology, PDNA approach), discusses evidence for and against various sedation practices based on procedure type, reviews existing sedation guidelines, and offers practical recommendations for the clinical electrophysiologist. EP Procedures—Evidence for Sedation Practices