Conscious sedation with the combination of midazolam and fentanyl is effective and safe for cryoablation of paroxysmal atrial fibrillation.

Abstract

Introduction: Studies on anesthesia for cryoablation, one of the methods used in the treatment of atrial fibrillation (AF), and its effect on perioperative parameters are limited.

Aim: To compare the effects of conscious sedation with a combination of midazolam-fentanyl and unconscious sedation with propofol-midazolam on the success of the procedure.

Material and methods: 242 patients who underwent AF cryoablation for the first time were included. The ASA score and baseline SaO₂ before the procedure, and the minimum SaO₂, systolic and diastolic blood pressure change and the Richmond Agitation Sedation Scale (RASS) score during the procedure were obtained. Study data were divided into 2 groups - conscious sedation and unconscious sedation - and compared.

Results: Demographic, laboratory and echocardiographic findings did not differ significantly between the two groups (p > 0.05). When the hemodynamic parameters of the periprocedural AF ablation process and the effects of anesthesia were examined according to the anesthesia groups of the patients, minimum SaO₂ during the procedure was significantly higher in the group that underwent conscious sedation (93.6 ±2.21% vs. 92.4 ±1.96% and p < 0.01). RASS score, blood pressure changes were found to be significantly lower in the conscious sedation group (p < 0.01 for each). However, procedural time, fluoroscopy time, ASA score, non-invasive mechanical ventilation (NIMV) requirement, basal SaO₂, procedure success and frequency of AF recurrence were not significantly different between prolonged recovery groups (p > 0.05 for each).

Conclusions: In our study, it was found that the conscious sedation preference during AF cryoablation could be applied with similar success and recurrence compared to unconscious sedation with propofol and midazolam.