Simplified propofol-based deep sedation by electrophysiologists: Safe and versatile for pulsed field and thermal ablation.

BACKGROUND

Pulsed field ablation (PFA) induces substantial procedural pain and typically requires deep sedation or general anesthesia. However, limited anesthesia resources constrain broad PFA adoption.

OBJECTIVE

We evaluated a simplified propofol-based deep sedation (s-DS) protocol for its safety, feasibility, and adaptability across various ablation modalities.

METHODS

Between May 2023 and June 2025, 497 consecutive patients underwent ablation under an s-DS regimen (propofol infusion and low-dose fentanyl only) by the electrophysiology laboratory staff. Procedures included PFA (n = 403) and thermal ablation (n = 94) across diverse arrhythmia types. Sedation parameters, hemodynamics, and recovery metrics were prospectively recorded. The study was structured in 2 phases: implementation phase (phase 1 n = 144) and routine adoption (phase 2 n = 353). Time to the ward (TTW) served as a surrogate of team proficiency and workflow efficiency.

RESULTS

s-DS was feasible and safe. Urgent conversion to general anesthesia occurred in 1 patient (0.2%), and transient mask ventilation was required in 9 (1.8%). PFA required higher fentanyl doses (P < .001), induced greater mean arterial blood pressure reductions (P = .004), and longer TTWs (P < .001) than thermal ablation, whereas oxygen saturation and respiratory support were comparable. TTW significantly declined with increasing operator and nursing experience (P < .001). No major adverse events, airway complications, or late respiratory failures occurred.

CONCLUSION

s-DS by electrophysiology laboratory staff enabled safe, versatile, effective, and pain-free ablations across all energy sources and arrhythmia types. s-DS offered a resource-efficient workflow with short TTW and reduced the need for prolonged postprocedure observation.