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

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. We evaluated of the anesthetic drugs use and patients’ pain experience during vHPSD PV isolation.

Fifty-eight patients, with paroxysmal and persistent atrial fibrillation (AF), treated with QDot Micro catheter and vHPSD (90 w for 4 s) (vHPSD group), were compared with the last 33 patients treated with a surround flow contact force-sensing catheter guided by the ablation index (450 anteriorly at 50 W, 330 posteriorly at 40 W) (AI group). Anesthetic drugs use was compared as well as pain experience, measured using a 0–10 scale.

All PVs were acutely isolated. Procedural time (78 ± 10 min vs 84 ± 12 min, p = 0.012), fluoroscopy time (369 ± 139 s vs 441 ± 172 s, p = 0.03), and RF time in the vHPSD group (8.3 ± 2.1 min) were shorter than in the AI group (25 ± 11 min, p < 0.001). Only 4 patients experienced an access site-related vascular complication (groin hematoma). Midazolam was required in 36 (62%) vHPSD group patients vs 31 (94%) AI group patients (p < 0.001). Fentanyl was required in 4 (7%) vHPSD group patients vs 25 (76%) AI group patients (p < 0.001). No patients required general anesthesia. Twenty-two (38%) vHPSD group patients underwent PV isolation without any anesthetic drug. Pain experience was significantly lower in vHPSD group (4.9 ± 2 vs 6.6 ± 1.8, p < 0.001).

vHPSD radiofrequency ablation for PVI can be performed under conscious sedation using only benzodiazepine in most of patients without compromising patient pain experience.