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.