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Two patients required deep sedation to control arrhythmic storm, and the two others were under respiratory support after cardiogenic shock.
Discussion The main finding of the study is that conscious sedation using powerful pain killers, for epicardial VT mapping and ablation, is safe and comfortable.
No sedation-related complications were observed and the presence of an anesthesiologist was not necessary. General anesthesia provides comfort, but positive air pressure lowers further blood pressure in unstable patients. Another inconvenient consequence of using deep sedation is the difficulty to induce arrhythmia; propofol 5, 6 and etomidate 7 have been utilized for suppressing arrhythmia storm, and desflurane and sevoflurane have been demonstrated to inhibit spontaneous postinfarction ventricular arrhythmias in dogs.
The left phrenic nerve lies on the pericardium close to the lateral wall of the left ventricle.
Before ablating in this area, pacing at high output helps localization of the nerve, and avoids diaphragmatic paralysis by RF injury.
Sufentanil is 5—10 times more potent than fentanil, 12, 13 with similar or slightly shorter duration of action. A recent study evaluated deep sedation propofol and midazolam in atrial fibrillation ablation.
Mandel et al 17 described a case in which remifentanil and midazolam were employed for epicardial VT ablation.
They used 0.
Remifentanil is also a powerful painkiller with a short half-life 3—4 min. With this opioid, patients are immediately lucid after stopping infusion. In our experience with sufentanil, we had no problems of overdose or analgesia-related complications, despite its relatively long half life.
In, Brugada et al 18 reported their experience in epicardial VT ablation.
They performed 10 procedures under conscious sedation using diazepam 10 mg before starting and fentanil; they do not describe details of the sedation and analgesia protocols in the paper.
VT ablation is a complex procedure for the electrophysiologist, and supervising sedation requires further concentration.
With this analgesia strategy, patient preparation time is shorter than procedures under general anesthesia.
It is easy to plan for patients in emergency situations.
I was planning it to be a tapering page. If the pain was intolerable or symptoms requested deeper sedation during the bacterium, the delivery was terminated and that site was complicated for ablation.
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