Results
Forty-nine consecutive patients who underwent AF ablation were included
in the analysis. Twenty-three belonged to the propofol group (group 1)
and twenty-six to the dexmedetomidine group (group 2). Patient
characteristics were similar between the two groups (Table 1). Eleven
out of 23 patients (48%) had paroxysmal AF in group 1 compared to 16/26
(61%) in group 2. Either patients with paroxysmal or persistent AF
underwent PVI; 7 patients in the propofol group underwent EC at the
beginning of the procedure compared to 11 patients in the
dexmedetomidine group.
Baseline hemodynamic variables, including arterial blood pressure, heart
rate and oxygen saturation were not significantly different between
groups (Table 2).
Drug administration data are reported in Table 3. During the procedure,
in 8 patients out of 23 (35%) in group 1, a reduction of the propofol
infusion rate was necessary; 3 of them underwent EC at the beginning of
the procedure. In group 2, 7 patients required dexmedetomidine infusion
rate reduction during the procedure (27%); however, 5/7 were patients
who underwent EC at the beginning of the procedure for which propofol
had been used in combination.
Inter-group comparison of hemodynamic variables during the procedure
showed that there was no statistically significant difference between
the two groups (Tables 2 and 4), despite a trend in favor of
dexmedetomidine in terms of better blood pressure control and better
oxygen saturation. Indeed, persistent hypotension (failure to maintain a
systolic blood pressure > 90 mmHg) at a drug infusion rate
required to achieve adequate sedation was observed in 3 patients in the
propofol group and in none in the dexmedetomidine group (p = 0.057). It
resolved with propofol infusion rate reduction and fluid challenge.
Three patients in group 1 experienced respiratory depression (sustained
oxygen desaturation < 90%) compared to 0 patients in group 2
(p = 0.057). All but one resolved with temporary propofol cessation,
whereas in 1 patient few minutes of bag-and-mask ventilation was
necessary. Two patients out of 26 in group 2 experienced a transient
reduction in the heart rate during ablation (< 45 bpm), which
promptly resolved with pacing from the catheters inside the heart.
There was no other serious complication related to the ablation
procedure (no death, stroke, phrenic nerve damage, atrio-esophageal
fistula, pericardial tamponade or effusion, vascular complication,
etc.).
Complete PVI was successfully achieved in every patient. Mean procedural
time was 138.5 ± 36.6 minutes in group 1 and 154 ± 43.3 minutes in group
2 (p = 0.184). Mean fluoroscopy time was 10.7 ± 6.8 minutes in group 1
and 10.1 ± 7.4 minutes in group 2 (p = 0.747).
After the procedure, patients were observed in the recovery unit for 60
minutes and full recovery was obtained in all patients.