Background: Pulsed field ablation (PFA) is a novel treatment modality for atrial fibrillation (AF) that uses high-voltage electric fields to induce myocardial electroporation. Despite its favorable safety profile, PFA can provoke muscle contractions and patient discomfort. Optimized sedation strategies are critical to ensure procedural tolerability.
Aims: This study aims to evaluate feasibility, safety, and patient experience of deep sedation during pulsed field ablation using a novel variable loop catheter (VLC).
Methods: Consecutive patients with AF undergoing ablation with the VLC were prospectively enrolled. All procedures were performed under deep sedation guided by a standardized protocol including midazolam, fentanyl, and contiunous propofol infusion. Hemodynamic monitoring included non-invasive blood pressure measurements and continuous oximetry. Sedation depth was monitored using the Richmond Agitation–Sedation Scale (RASS). Patient experience was assessed with a Visual Analogue Scale (VAS) and a standardized questionnaire.
Results: 59 patients (mean age 65 ± 10 years; 64% male) were included. All procedures were completed under deep sedation without conversion to general anesthesia. The median peak propofol rate was 7.0 mg/kg/h (mean 7.4 ± 2.7 mg/kg/h), with cumulative dosages tailored to individual tolerance. Median RASS score during ablation was –4 (IQR –3 to –5). No sedation-related complications, such as hypoxia, hypotension, or airway intervention, were observed. Complete PVI was achieved in all patients with no device-related adverse events. Overall, 94% of patients rated their experience with sedation and analgesia as good or excellent.
Conclusion: Deep sedation is a feasible, safe, and an effective strategy for PFA using the VLC. These findings support the routine use of monitored deep sedation as a viable alternative to general anesthesia in PFA procedures.
