Outcomes of deep sedation for catheter ablation of paroxysmal supraventricular tachycardia, with adaptive servo ventilation

• Main Authors: Tatsuya Hayashi, Akira Mizukami, Shunsuke Kuroda, Ryo Tateishi, Nozomu Kanehama, Shinichi Tachibana, Kazuto Hayasaka, Jiro Hiroki, Hirofumi Arai, Kenji Yoshioka, Ryota Iwatsuka, Daisuke Ueshima, Akihiko Matsumura, Masahiko Goya, Tetsuo Sasano
• Format: Article
• Language: English
• Published: Wiley 2021-02-01
• Series: Journal of Arrhythmia
• Subjects: adaptive servo ventilation; catheter ablation; deep sedation; dexmedetomidine; paroxysmal supraventricular tachycardia
• Online Access: https://doi.org/10.1002/joa3.12476

Abstract Background Catheter ablation for paroxysmal supraventricular tachycardia (PSVT) is an established treatment, but the effect of deep sedation on PSVT inducibility remains unclear. Aim We sought to examine PSVT inducibility and outcomes of catheter ablation under deep sedation using adaptive servo ventilation (ASV). Methods We retrospectively evaluated consecutive patients who underwent catheter ablation for PSVT under deep sedation (Propofol + Dexmedetomidine) with use of ASV. Anesthetic depth was controlled with BIS™ monitoring, and phenylephrine was administered to prevent anesthesia‐induced hypotension. PSVT induction was attempted in all patients using extrastimuli at baseline, and after isoproterenol (ISP) infusion when necessary. Results PSVT was successfully induced in 145 of 147 patients, although ISP infusion was required in the majority (89%). The PSVT was atrioventricular nodal reentrant tachycardia (AVNRT) in 77 (53%), atrioventricular reciprocating tachycardia (AVRT) in 51 (35%), and atrial tachycardia (AT) in 17 (12%). A higher ISP dose was required for AT compared to other PSVT (AVNRT: 0.06 (IQR 0.03‐0.06) vs AVRT: 0.03 (0.02‐0.06) vs AT: 0.06 (0.03‐0.12) mg/h, P = .013). More than half (51%) of the patients developed hypotension requiring phenylephrine; these patients were older. Acute success was obtained in 99% (patients with AVNRT had endpoints with single echo on ISP in 46%). Long‐term success rate was 136 of 144 (94%) (AVNRT 96%, AVRT 92%, and AT 93%). There were no complications related to deep sedation. Conclusions Deep sedation with use of ASV is a feasible anesthesia strategy for catheter ablation of PSVT with good long‐term outcome. PSVT remains inducible if ISP is used.