https://doi.org/10.1007/s00392-025-02737-x
1Christian-Albrechts-Universität zu Kiel Medizinischen Fakultät Kiel, Deutschland; 2Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Kiel, Deutschland
There is no current standard of anesthetic management for CA of VT. Data on VT ablation under deep sedation with propofol and fentanyl are limited.
Objective:
The aim was to evaluate feasibility and safety of CA of VT under deep sedation with propofol and fentanyl.
Methods:
Data from 134 procedures in 106 patients undergoing CA for VT under sedation with propofol and fentanyl were prospectively included. Three groups were defined and compared: Group 1 (no VT induction, n=36); Group 2 (induction of hemodynamically unstable VT, n=42), Group 3: (induction of hemodynamically stable VT, n=56).
Results:
Median age was 64 years, 84% were male, and 97% had structural heart disease. Group 2 had higher proportion of patients with DCM (p=0.04) and severely reduced LVEF (p=0.024). Unipolar RF ablation was performed in 95% of procedures, bipolar in 12%, and alcoholablation in 4%. Epicardial access was utilized in 18%. Radiation dose was higher in Group 2 (p=0.04), while postablational non- inducibility was more frequently achieved in Group 3 (p=0.045). There were no cases of profound hypotension or intubation associated with sedation. CPR was performed in seven procedures due to PEA, all in Group 2( p<0.001) with ROSC achieved in all cases within three minutes. No differences were observed in complication rates or hospital stay.
Conclusion:
CA for VT under deep sedation with propofol and fentanyl in patients with structural heart disease is feasible and safe, irrespective of VT induction, mapping and ablation approach. Hemodynamic instability, hypotension and desaturation can be effectively managed.
Graphical abstract
Figure 1. Etiologies of structural heart disease in patient cohort and distribution according to VT induction group
Figure 2. (A) Radiation dose; (B) Radiation duration; (C) Procedure duration; (D) RF energy delivery time across three groups. RF, radiofrequency
Figure 3. SpO2 levels throughout the procedure. (A) Median SpO2 levels of over 20-minute intervals; (B) Median time spent in different SpO2 ranges.