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  • 1
    Online Resource
    Online Resource
    Safety Aspects of Deep Sedation during Catheter Ablation of Atrial Fibrillation : PROPOFOL SEDATION DURING AF-ABLATION
    Wiley ; 2012
    In:  Pacing and Clinical Electrophysiology Vol. 35, No. 1 ( 2012-01), p. 38-43
    Details
    In: Pacing and Clinical Electrophysiology, Wiley, Vol. 35, No. 1 ( 2012-01), p. 38-43
    Type of Medium: Online Resource
    ISSN: 0147-8389
    URL: Issue
    URL: Article
    DOI: 10.1111/pace.2012.35.issue-1
    DOI: 10.1111/j.1540-8159.2011.03260.x
    Language: English
    Publisher: Wiley
    Publication Date: 2012
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  • 2
    Online Resource
    Online Resource
    High Patient Satisfaction with Deep Sedation for Catheter Ablation of Cardiac Arrhythmia
    Wiley ; 2017
    In:  Pacing and Clinical Electrophysiology Vol. 40, No. 5 ( 2017-05), p. 585-590
    Details
    In: Pacing and Clinical Electrophysiology, Wiley, Vol. 40, No. 5 ( 2017-05), p. 585-590
    Abstract: Patients’ satisfaction with invasive procedures largely relies on periprocedural perception of pain and discomfort. The necessity for intraprocedural sedation during catheter ablation of cardiac arrhythmias for technical reasons is widely accepted, but data on patients’ experience of pain and satisfaction with the procedural sedation are scarce. We have assessed patients’ pain and discomfort during and after the procedure using a standardized questionnaire. Methods One hundred seventeen patients who underwent catheter ablation answered a standardized questionnaire on periprocedural perception of pain and discomfort after different anesthetic protocols with propofol/midazolam with and without additional piritramide and ketamine/midazolam. Results Patients report a high level of satisfaction with periprocedural sedation with 83% judging sedation as good or very good. The majority of patients was unconscious of the whole procedure and did not recollect experiencing pain. Procedural pain was reported by 7.7% of the patients and 16% reported adverse effects, e.g., postprocedural nausea and episodes of headache. Conclusion The results of our study show that deep sedation during catheter ablation of cardiac arrhythmias is generally well tolerated and patients are satisfied with the procedure. Yet, a number of patients reports pain or adverse events. Therefore, studies comparing different sedation strategies should be conducted in order to optimize sedation and analgesia.
    Type of Medium: Online Resource
    ISSN: 0147-8389 , 1540-8159
    URL: Issue
    URL: Article
    DOI: 10.1111/pace.2017.40.issue-5
    DOI: 10.1111/pace.13063
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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  • 3
    Online Resource
    Online Resource
    Left Atrial Appendage Conduction Jump for Real‐Time Evaluation of Conduction Block Over the Anterior Mitral Annulus Line
    Wiley ; 2015
    In:  Journal of Cardiovascular Electrophysiology Vol. 26, No. 7 ( 2015-07), p. 730-736
    Details
    In: Journal of Cardiovascular Electrophysiology, Wiley, Vol. 26, No. 7 ( 2015-07), p. 730-736
    Abstract: Evaluation of conduction over a linear ablation lesion at the anterior mitral annulus can be time‐consuming and difficult during ongoing radiofrequency application. The purpose of this study was to validate conduction time from the beginning of the p wave and from the coronary sinus ostium to the left atrial appendage (LAA) as a new method of conduction block surveillance. Methods Conduction across the anterior mitral annulus line was evaluated using a total of 55 patients. We verified completeness of conduction block by standard techniques including differential pacing, double potential mapping and activation mapping. Those methods were compared to the new method of observing an abrupt prolongation of conduction time into the LAA as well as a conduction sequence change on a circular multipolar mapping catheter placed inside the LAA during sinus rhythm. Results Bidirectional conduction block across the ablated line was achieved in 51 (92.7%) of the patients. Prior to ablation, mean conduction time across the line was 59 ± 21 milliseconds. This value increased to 163 ± 43 milliseconds after a successful ablation. An abrupt prolongation of conduction time into the LAA of at least 50 milliseconds was observed in all patients at the moment when a complete conduction block was achieved. Additionally, a change of conduction sequence recorded with the multi‐electrode catheter placed in the LAA was observed in all of these patients. Conclusions A sudden jump of p wave and coronary sinus ostium to LAA conduction time together with a change of conduction sequence recorded with a multi‐electrode catheter placed inside the LAA during sinus rhythm is a simple and reliable approach for beat‐to‐beat surveillance of conduction block across the anterior mitral annulus during radiofrequency ablation.
    Type of Medium: Online Resource
    ISSN: 1045-3873 , 1540-8167
    URL: Issue
    URL: Article
    DOI: 10.1111/jce.2015.26.issue-7
    DOI: 10.1111/jce.12670
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 2037519-0
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  • 4
    Online Resource
    Online Resource
    Pain Reactions during Pulmonary Vein Isolation under Deep Sedation: Cryothermal versus Radiofrequency Ablation
    Wiley ; 2016
    In:  Pacing and Clinical Electrophysiology Vol. 39, No. 5 ( 2016-05), p. 452-457
    Details
    In: Pacing and Clinical Electrophysiology, Wiley, Vol. 39, No. 5 ( 2016-05), p. 452-457
    Abstract: Left atrial ablation can be accompanied by discomfort or pain. The purpose of this study was to systematically compare pain reactions during ablation of atrial fibrillation under deep sedation with cryothermal and radiofrequency energy. Methods and Results Circumferential ablation was performed in patients with atrial fibrillation using either radiofrequency (RF) or cryoenergy. Deep sedation was achieved with a combination of propofol and midazolam. Pain reactions were counted and painful ablation sites located. To determine the severity of the pain reactions a Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Assessment Scale was used: 79 patients (53 RF‐ vs 26 Cryoablations) were included. A total of 92% of patients treated with RF energy showed ≥1 pain reaction during the procedure compared to only 13% in the cryoenergy group ( 〈 0.001). The total number of pain reactions was significantly higher in the RF energy group (3.6 ± 4.7 vs1.3 ± 0.6, P = 0.005). Determination of painful sites was performed in the RF group only. Pain reactions were significantly more often observed during RF application left superior pulmonary vein (LSPV) ostium compared to other left atrial ablation sites (Total FLACC Score 2.8 ± 0.6 LSPV, 1.4 ± 0.4 left inferior pulmonary vein [P = 0.009] , 1.4 ± 0.3 right superior pulmonary vein [P = 0.044], 1.1 ± 0.3 right inferior pulmonary vein [P = 0.032] ). Conclusions Our results show that despite deep sedation pain reactions often occur during RF ablation. Knowledge of areas with more frequent pain reactions may help electrophysiologists to reduce pain reactions and related patient movements. Ablation with cryoenergy was significantly less painful compared to ablation with RF energy. Cryoablation therefore may be considered for patients at a higher risk for anesthesia‐related complications.
    Type of Medium: Online Resource
    ISSN: 0147-8389 , 1540-8159
    URL: Issue
    URL: Article
    DOI: 10.1111/pace.2016.39.issue-5
    DOI: 10.1111/pace.12840
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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