Efficacy and safety of operator-directed, nurse-administered propofol sedation in atrial fibrillation ablation

Abstract

Aims Adequate sedation and analgesia are essential for catheter ablation of atrial fibrillation (AF) to ensure patient comfort and procedural safety. However, the availability of cardiac anaesthesiology is limited. This study evaluated the efficacy and safety of an operator-directed, nurse-administered (ODNA) sedation protocol using propofol and remifentanil during AF ablation. Methods and results In this prospective, single-centre observational cohort study, consecutive patients undergoing catheter ablation for AF from August 2023 to March 2024 were enrolled. Sedation-related adverse events and intra-procedural vital signs were recorded. Sedation depth was assessed using the Modified Observer's Alertness/Sedation (MOAA/S) scale, and patient satisfaction was evaluated using the Visual Analogue Scale (VAS). A total of 230 patients were included (mean age 61.9 years; 76.1% male). Of these, 7.4% had a body mass index of >= 30 kg/m(2), and 4.3% had obstructive sleep apnoea. Paroxysmal AF accounted for 30.9%, and the mean procedure time was 174 min. The primary outcome-defined as unplanned sedation interruption, intubation, or continuous vasopressor requirement-occurred in 2.2% of patients. Intermittent hypotension (mean arterial pressure: <60 mmHg) occurred in 36.1% of patients, but no patient required continuous vasopressors. The mean MOAA/S score was 0.4 +/- 0.4. Post-procedural surveys showed high satisfaction (mean VAS: 8.8) and low maximal pain (VAS: 0.9). Conclusion An ODNA protocol using propofol and remifentanil provides effective and safe sedation for AF ablation, with high patient satisfaction and minimal serious adverse events.