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

## TL;DR

This study finds that nearly half of patients undergoing heart procedures with sedation experience breathing issues, and body composition factors can help predict who is at risk.

## Contribution

The study identifies body composition and clinical factors as predictors of respiratory complications during sedation for heart procedures.

## Key findings

- Respiratory complications occurred in 42.2% of patients during sedation for atrial fibrillation ablation.
- A predictive model using factors like neck circumference and visceral fat percentage showed moderate accuracy (AUROC 0.72).

## Abstract

•Respiratory complications are common during deep sedation for atrial fibrillation ablation.•Body composition is associated with the risk of respiratory complications.•Improved pre-assessment may support pre-procedural risk stratification.

Respiratory complications are common during deep sedation for atrial fibrillation ablation.

Body composition is associated with the risk of respiratory complications.

Improved pre-assessment may support pre-procedural risk stratification.

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.

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.

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.

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.