Servatius, Helge; Küffer, Thomas; Baldinger, Samuel H.; Asatryan, Babken; Seiler, Jens; Tanner, Hildegard; Novak, Jan; Lam, Anna; Noti, Fabian; Haeberlin, Andreas; Madaffari, Antonio; Sweda, Romy; Mühl, Aline; Branca, Mattia; Dütschler, Sophie; Erdoes, Gabor; Stüber, Frank; Theiler, Lorenz; Reichlin, Tobias and Roten, Laurent (2022). Dexmedetomidine versus Propofol for Operator-Directed Nurse-Administered Procedural Sedation during Catheter Ablation of Atrial Fibrillation: a Randomized Controlled Study. Heart rhythm, 19(5), pp. 691-700. Elsevier 10.1016/j.hrthm.2021.12.028
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BACKGROUND
Operator-directed nurse-administered (ODNA) sedation with propofol is the preferred sedation technique for catheter ablation of atrial fibrillation (AF) in many centers.
OBJECTIVE
We aimed to investigate whether Dexmedetomidine, an α2-adrenergic receptor agonist, is superior to propofol.
METHODS
We randomized 160 consecutive patients undergoing first AF ablation to ODNA sedation by dexmedetomidine (DEX group) versus propofol (PRO group), according to a standardized protocol. Patients were unaware of treatment allocation. The primary endpoint was a composite of inefficient sedation, termination/change of sedation protocol or procedure abortion, hypercapnia (transcutaneous CO2 >55 mmHg), hypoxemia (SpO2 <90%) or intubation, prolonged hypotension (systolic blood pressure <80 mmHg), and sustained bradycardia necessitating cardiac pacing. Secondary endpoints were the components of the primary endpoint and patient satisfaction with procedural sedation, as assessed by a standardized questionnaire the day following ablation.
RESULTS
The primary endpoint occurred in 15 DEX group and 25 PRO group patients (19% vs. 31%; p=0.068). Hypercapnia was significantly more frequent in PRO group patients (29% vs. 10%; p=0.003). There was no significant difference among the other components of the primary endpoint, no procedure was aborted. Patient satisfaction was significantly better in PRO group patients (visual analog scale 0-100; median 100 in PRO group vs. median 93 in DEX group; p<0.001).
CONCLUSION
Efficacy of ODNA sedation with dexmedetomidine was not different to propofol. Hypercapnia occurs less frequent with dexmedetomidine, but patient satisfaction is better with propofol sedation. In selected patients, dexmedetomidine may be used as an alternative to propofol for ODNA sedation during AF ablation. (ClinicalTrials.gov number NCT03844841).
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