Introduction
The current Coronavirus disease (COVID-19) pandemic has brought many
medical and organizational challenges to every healthcare system,
creating a shortage of critical care and anesthesia staff.
Anesthesiologists are playing a fundamental role in the fight against
COVID-19 and the majority of them have been reassigned from the
perioperative setting to intensive care units.
While many elective procedures have been postponed or suspended during
the pandemic, many urgent or semi-urgent interventional cardiology
procedures were overall preserved.
It is now well known that arrhythmias are frequently associated with
COVID-19 increased morbidity and mortality, with atrial fibrillation
(AF) being the most frequent.1 Transcatheter ablation
has become the most common technique to treat
patients.2 However, AF ablation is often a relatively
long procedure and usually requires sedation to avoid patient’s
discomfort and movements. Therefore, many centers in the United States
and in Europe perform AF ablation procedures under general anesthesia
(GA). Nonetheless, deep sedation, with an adequate level of analgesia,
has become a safe and effective alternative, avoiding the risks related
to GA.3-5 Moreover, if the sedation protocol is
overseen by cardiologists/electrophysiologists, anesthesiologists are
free to be redeployed from the operating rooms to the care of COVID-19.
Many combinations of drugs have been used for sedation during catheter
ablation of AF. While propofol administration has shown to achieve a
better and more predictable level of sedation than benzodiazepine and
opiates, adverse sedative effects might still be
present.6 Dexmedetomidine, a highly selective
alpha2-adrenoreceptor agonist, offers effective sedation and analgesia
combined with the unique characteristic to cause no respiratory
depression.7-8
The aim of our study was to compare the safety and efficacy of
dexmedetomidine administered by electrophysiologists with those of
propofol operated by anesthesiologists in patients who underwent
transcatheter AF ablation.