A Comparison of Safety and Outcome Using Three Different Sedation Strategies During Pulsed Field Ablation for Atrial Fibrillation.

BACKGROUND: Pulsed field ablation (PFA) is an emerging modality for atrial fibrillation (AF) ablation. However, adequate sedation of patients during treatment is imperative. OBJECTIVE: Our aim was to compare safety and outcome after deep sedation (DS) managed by electrophysiology staff (EP-DS), DS by an anaesthesia nurse (AN-DS), and general anaesthesia (GA) during PFA AF ablation. METHODS: All Danish patients undergoing first-time AF ablation with pentaspline PFA technique from 2021 to 2024 were included. Patients were stratified according to sedation strategy. EP-DS and AN-DS were defined as sedation without assisted ventilation managed by EP staff and an anaesthesia nurse, respectively. Patients in GA underwent endotracheal intubation and were monitored by anaesthesia staff. Patient selection for the sedation strategy was based on the institutional practice. RESULTS: Of 1269 patients, 661 (52%) underwent EP-DS, 173 (14%) underwent AN-DS, and 435 (34%) underwent GA. Overall, sedation complications were few, and no procedures were abandoned due to adverse effects of sedation. In the EP-DS group, the anaesthesiologist was unexpectedly called for back-up in 1 (0.2%) patient due to prolonged hypotension during the procedure. In the AN-DS group, the anaesthesiologist was called due to desaturation in 1 patient (0.6%) but without the need for escalation to intubation. In the GA group, no periprocedural sedation complications occurred. We found no difference in 1-year atrial tachycardia recurrence between sedation groups. CONCLUSION: In this nationwide cohort, EP staff-administered deep sedation was feasible and associated with few clinically significant sedation-related adverse events during PFA. No significant differences in observed atrial tachyarrhythmia recurrence rates were identified between sedation strategies.