Peri-procedural respiratory complications in patients undergoing pulmonary vein isolation under procedural sedation and analgesia: Incidence and predictive factors

Background and Objectives: Catheter ablation (CA) in patients with atrial fibrillation (AF) can be performed under procedural sedation and analgesia (PSA). Risk factors for respiratory complications during PSA are unclear. We aimed to determine the incidence and severity of respiratory complications during PSA and identify predictive factors for development of per-procedural respiratory complications. Methods: Patients with AF receiving PSA in the MUMC⁺ for CA were included. Respiratory complications were defined as the need of an oral/nasal airway, a non-rebreathing mask, high flow oxygen, a hypoxemic event or conversion to general anaesthesia. Results: In total 232 procedures (42.2 % cryoballoon ablation; 57.3 % RF ablation) were performed. Most patients were male (62.1 %), with a mean age of 64 ± 9.3 (mean ± SD), an activity level ≥ 4 METS (94.8 %) and paroxysmal AF (68.5 %). Respiratory complications occurred in 42.2 %. A multiple logistic regression model including sedation duration, age > 50 years, neck circumference > 40 cm, visceral fat percentage, self-reported tiredness, apnoea hypopnoea index (AHI), medical background of diagnosed sleep apnoea (OSAS) and chronic obstructive pulmonary disease (COPD) identified patients at risk with an AUROC 0.72, 95 % CI: 0.65–0.78. Conclusion: In patients with AF undergoing CA under PSA, per-procedural respiratory complications occur in 42.2 % of the cases. Duration of the PSA, a neck circumference > 40 cm, visceral fat percentage, tiredness, AHI, OSAS and COPD may help to identify patients at risk for per-procedural respiratory complications. Although age > 50 years is a recognized risk factor, this cut-off had limited discriminative value in our cohort, as most patients were older than 50.