Peri-procedural anesthesia and patient pain experience in pulmonary vein isolation by means of very high power short duration radiofrequency ablation

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Very high-power short-duration (vHPSD) temperature-controlled radiofrequency ablation (vHPSD) may reduce ablation times and improve patient tolerability, permitting pulmonary vein (PV) isolation under mild conscious sedation. PURPOSE: Evaluate the anesthetic drugs use and patients ‘pain experience during vHPSD PV isolation. METHODS: Thirty-three consecutive patients, with paroxysmal atrial fibrillation (AF), treated with QDot Micro catheter and vHPSD (90 w for 4 s) (vHPSD Group), were compared with the last 33 consecutive patients, with paroxysmal AF, treated with a surround flow contact force-sensing catheter guided by the ablation index (450 at anterior and superior sites at 50 W, 330 at posterior and inferior sites at 40 W) (AI Group). Anesthetic drugs (midazolam and fentanyl) use were compared as well as pain experience, measured using a 0-10 scale. RESULTS: All PVs were isolated. PV isolation ablation time in the vHPSD Group (5.9±1.4 min) was shorter than in the AI Group (25±11 min, p<0.001). Pain experience was significantly lower in vHPSD group (4.5±2 vs 6.6±1.8, p< 0.001). No patients required general anesthesia; fentanyl use was required in 4 vHPSD Group patients vs 25 AI Group patients (p<0.001). A lower dose of midazolam was required in vHPSD Group (2.3±1.2 mg vs 3.6±1.7 mg, p < 0.001). CONCLUSIONS: vHPSD radiofrequency ablation for PVI can be performed under conscious sedation using only benzodiazepine in most of patients without compromising patient pain experience.