# Sleep Apnea and Abnormal Respiratory Patterns with Deep Sedation during Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation

## TL;DR

This study finds that obstructive breathing issues are common during deep sedation for heart procedures in patients with atrial fibrillation and sleep apnea.

## Contribution

The study identifies obstructive respiratory patterns during RFCA with deep sedation and suggests combining propofol with dexmedetomidine to reduce risks.

## Key findings

- Respiratory events during RFCA with deep sedation were mainly obstructive.
- Using dexmedetomidine with propofol reduced propofol dose and airway use.
- Higher propofol doses were linked to increased respiratory instability during the procedure.

## Abstract

Abnormal respiration during radiofrequency catheter
ablation (RFCA) with deep sedation in patients with atrial fibrillation (AF) can
affect the procedure’s success. However, the respiratory pattern during RFCA with
deep sedation remains unclear. This study aimed to investigate abnormal
respiration during RFCA and its relationship with sleep apnea in patients with
AF.

We included patients with AF who underwent RFCA with
cardiorespiratory monitoring using a portable polygraph both at night and during
RFCA with deep sedation. The patients were divided based on the administered
sedative medicines.

We included 40 patients with AF. An
overnight sleep study revealed that 27 patients had sleep apnea; among them, 9
showed central predominance. During RFCA with deep sedation, 15 patients showed
an abnormal respiratory pattern, with 14 patients showing obstructive
predominance. Further, 17 and 23 patients were administered with propofol alone
and dexmedetomidine plus propofol, respectively. There was no significant
between-group difference in the respiratory event index (REI) at night (7.9 vs.
9.3, p = 0.744). However, compared with the group that received
dexmedetomidine plus propofol, the propofol-alone group showed a higher REI
during RFCA (5.4 vs. 2.6, p = 0.048), more frequent use of the airway
(47% vs. 13%, p = 0.030), and a higher dose of administered propofol
(3.9 mg/h/kg vs. 1.2 mg/h/kg, p < 0.001). Multivariable analysis
revealed that only the propofol amount was associated with REI during RFCA (p =
0.007).

Our findings demonstrated that respiratory
events during RFCA with deep sedation were mainly obstructive. Propofol should be
administered with dexmedetomidine rather than alone to reduce the propofol amount
and avoid respiratory instability.