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.