Conscious sedation with the combination of midazolam and fentanyl is effective and safe for cryoablation of paroxysmal atrial fibrillation

Introduction: Studies on anesthesia for cryoablation, one of the methods used in the treatment of atrial fibrillation (AF), and its effect on perioperative parameters are limited. Aim: To compare the effects of conscious sedation with a combination of midazolam-fentanyl and unconscious sedation with propofol-midazolam on the success of the procedure. Material and methods: 242 patients who underwent AF cryoablation for the first time were included. The ASA score and baseline SaO2 before the procedure, and the minimum SaO2, systolic and diastolic blood pressure change and the Richmond Agitation Sedation Scale (RASS) score during the procedure were obtained. Study data were divided into 2 groups - conscious sedation and unconscious sedation - and compared. Results: Demographic, laboratory and echocardiographic findings did not differ significantly between the two groups (p > 0.05). When the hemodynamic parameters of the periprocedural AF ablation process and the effects of anesthesia were examined according to the anesthesia groups of the patients, minimum SaO2 during the procedure was significantly higher in the group that underwent conscious sedation (93.6 +/- 2.21% vs. 92.4 +/- 1.96% and p < 0.01). RASS score, blood pressure changes were found to be significantly lower in the conscious sedation group (p < 0.01 for each). However, procedural time, fluoroscopy time, ASA score, non-invasive mechanical ventilation (NIMV) requirement, basal SaO2, procedure success and frequency of AF recurrence were not significantly different between prolonged recovery groups (p > 0.05 for each). Conclusions: In our study, it was found that the conscious sedation preference during AF cryoablation could be applied with similar success and recurrence compared to unconscious sedation with propofol and midazolam.