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Clinical Impact of Adaptive Servo-Ventilation on the Left Atrial Pressure during Catheter Ablation in Sedated Patients with Atrial Fibrillation
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  • Naohiko Kawaguchi,
  • Atsushi Suzuki,
  • Michio Usui,
  • Shunji Yoshikawa,
  • Shingo Watanabe,
  • Ryota Maeno,
  • Hirofumi Kujiraoka,
  • Kuniyoshi Sato,
  • Masahiko Goya,
  • Tetsuo Sasano
Naohiko Kawaguchi
Tokyo Yamate Medical Center
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Atsushi Suzuki
Tokyo Yamate Medical Center
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Michio Usui
Tokyo Yamate Medical Center
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Shunji Yoshikawa
Tokyo Yamate Medical Center
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Shingo Watanabe
Tokyo Yamate Medical Center
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Ryota Maeno
Tokyo Yamate Medical Center
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Hirofumi Kujiraoka
Tokyo Yamate Medical Center
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Kuniyoshi Sato
Tokyo Yamate Medical Center
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Masahiko Goya
Tokyo Medical and Dental University Hospital
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Tetsuo Sasano
Tokyo Medical and Dental University
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Abstract

Introduction Sedation during pulmonary vein isolation (PVI) of atrial fibrillation often provokes a decline in left atrial (LA) pressure (LAP) under atmospheric pressure and increases the risk of systemic air embolisms. This study aimed to investigate the efficacy of adaptive servo-ventilation (ASV) on the LAP in sedated patients. Methods and Results Fifty-one consecutive patients undergoing cryoballoon PVI were enrolled. All patients underwent sedation using propofol throughout the procedure. Sedation status was monitored by the bispectral index. After the transseptal puncture and inserting the long sheath into the LA, the LAP was measured via the sheath. Then, the ASV treatment was started, and the LAP was re-measured. The LAP before and after the ASV support was investigated. Before the ASV, the LAP during inspiratory phase was significantly smaller than that during expiratory phase (4.9±5.4 mmHg vs. 14.0±5.2 mmHg, p<0.01). The lowest LAP was -2.2±5.1 mmHg and was under 0 mmHg in 37 (73%) patients. After the ASV, the LAP during inspiratory phase significantly increased to 8.9±4.1 mmHg (p<0.01), and lowest LAP to 4.7±5.9 mmHg (p<0.01). The negative lowest LAP value became positive in 30/37(81%) patients. There were no statistical differences regarding obstructive sleep apnea (OSA), obesity, gender, or other comorbidities between patients with and without a negative lowest LAP after the ASV support. Conclusion ASV is effective for increasing the LAP above 0 mmHg and might prevent air embolisms during PVI. A negative LAP after the ASV was rare but occurred in patients even without comorbidities such as OSA and obesity