Deep Sedation in Catheter Ablation of Atrial Fibrillation

NCT ID: NCT06836999

Last Updated: 2025-03-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

1334 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-03-03

Study Completion Date

2027-12-31

Brief Summary

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The current practice of anesthesia for atrial fibrillation catheter ablation (CA) procedure is inconsistent, including general anesthesia, deep sedation, and conscious sedation.Due to the nature of deep sedation, it has been continuously gaining its position as one of the crucial components in standard practices of atrial fibrillation ablation during the last decade. Currently, a considerable number of procedures have been done using conscious sedation. Previous studies explored the benefits obtained from the employment of deep sedation in AF ablation procedures, mainly focused on pain reduction and intra-procedural safety. However, the benefits on long-term rhythmic outcomes, peri-procedural safety as well as benefits on procedural parameters and peri-procedural experiences from patients/ablators/lab staff have yet not to be thoroughly studied. We plan to conduct a prospective, multicenter, randomized, controlled trial to evaluate the benefits of deep sedation in catheter ablation of paroxysmal and persistent AF in multiple prospective, i.e., quantified intraprocedural patients / physicians / lab staffs / mapper clinical specialist experiences, and the procedure safety.

Detailed Description

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Conditions

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Atrial Fibrillation Atrial Fibrillation, Paroxysmal or Persistent Deep Sedations Conscious Sedation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
The present trial utilized a centralized randomization system (IWRS) to facilitate the competitive enrollment of study participants and treatment randomization grouping. The investigator (anesthesiologist) carries out the given treatment according to the grouping information of the study participants. Throughout the course of the study, the treatment groups were kept blind to the researchers, with the exception of the anesthesiologist, the sponsor, and the study participants.

Study Groups

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DS group

The CA procedure will be performed under deep sedation in the study group mainly with propofol for sedation and fentanyl for analgesic

Group Type EXPERIMENTAL

deep sedation

Intervention Type PROCEDURE

The deep sedation was inducted using atropine 0.5 mg iv administered 15 min before the procedure to avoid aspiration. In the EP lab, anesthesia preparation is performed, including invasive arterial blood pressure monitoring via puncture of the radial artery or brachial artery. Noninvasive BP monitoring every 5 minutes is also permitted. Subsequently, midazolam 1-2mg or accompanied with propofol 0.3-0.5 mg/kg is administered intravenously at the start of the CA procedure (i.e., femoral vein puncture), and fentanyl 25 µg is administered intravenously. Then, continuous titrated infusion of propofol 0.2-0.5mg/kg/h for anesthesia maintenance throughout the CA procedure. An additional iv fentanyl (25-50 µg) is administrated at the beginning of RF applications. Further boluses or additional drugs are administrated as needed to maintain analgesia during the procedure. The anesthesiologist is responsible for administering anesthesia and administering medication.

CS group

The CA procedure will be performed under conscious sedation in the control group mainly with fentanyl.

Group Type SHAM_COMPARATOR

Conscious sedation

Intervention Type PROCEDURE

This protocol is aimed at analgesia, with local infiltration of lidocaine for femoral vein puncture followed by intravenous administration of fentanyl (1-2 ug/kg/h). The operator determines the dose of fentanyl and midazolam. A midazolam 1-5 mg bolus is administrated before electrical cardioversion is performed or when the patient is nervous.

Interventions

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deep sedation

The deep sedation was inducted using atropine 0.5 mg iv administered 15 min before the procedure to avoid aspiration. In the EP lab, anesthesia preparation is performed, including invasive arterial blood pressure monitoring via puncture of the radial artery or brachial artery. Noninvasive BP monitoring every 5 minutes is also permitted. Subsequently, midazolam 1-2mg or accompanied with propofol 0.3-0.5 mg/kg is administered intravenously at the start of the CA procedure (i.e., femoral vein puncture), and fentanyl 25 µg is administered intravenously. Then, continuous titrated infusion of propofol 0.2-0.5mg/kg/h for anesthesia maintenance throughout the CA procedure. An additional iv fentanyl (25-50 µg) is administrated at the beginning of RF applications. Further boluses or additional drugs are administrated as needed to maintain analgesia during the procedure. The anesthesiologist is responsible for administering anesthesia and administering medication.

Intervention Type PROCEDURE

Conscious sedation

This protocol is aimed at analgesia, with local infiltration of lidocaine for femoral vein puncture followed by intravenous administration of fentanyl (1-2 ug/kg/h). The operator determines the dose of fentanyl and midazolam. A midazolam 1-5 mg bolus is administrated before electrical cardioversion is performed or when the patient is nervous.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

● Patients diagnosed with AF (paroxysmal, persistent, or long-standing) at 18-75 years old who are eligible for the CA procedure

Exclusion Criteria

* has received CA procedure for AF or atrial septal defect repair before enrollment
* left atrial diameter (LAD) ≥55 mm or thrombosis in the left atrium;
* eGFR\<30mL/min/1.73㎡
* a history of cerebrovascular disease within the last three months (including stroke and transient ischemic attack \[TIA\])
* acute or severe systemic infection
* intolerant to sedation or with a history suggestive of sleep apnea
* BMI \> 35 kg/㎡
* has contraindications to procedural sedation or refused to participate in this trial
* Congenital heart disease, thyroid dysfunction, severe hepatic insufficiency (Child-Pugh classification B-C), severe coagulation dysfunction (international normalized ratio (INR) \> 1.5 or partial activated prothrombin time (APTT) prolonged by ≥ 10 seconds, or plasma prothrombin time (PT) prolonged by ≥ 3 seconds, or fibrinogen (Fib) ≤ 1.5 g/L), or active bleeding
* pregnant women, breastfeeding women or women who plan to become pregnant during the study period, those who have a positive pregnancy test result during the screening period
* life expectancy \< 12 months
* those who have participated in other clinical drug trials within 3 months prior to enrollment
* those who are known to be allergic to any of the ingredients such as lidocaine, propofol, soybeans, peanuts, etc.
* those who, in the judgment of the investigator, are not suitable for this clinical study (e.g., not in line with the treatment that the research participants the treatment, research participant compliance, etc.).
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The First Affiliated Hospital of Dalian Medical University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Yunlong Xia, Ph.D

Role: PRINCIPAL_INVESTIGATOR

The First Affiliated Hospital of Dalian Medical University

Locations

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Anhui Provincial Hospital

Hefei, Anhui, China

Site Status

Guangdong Provincial People's Hospital

Guangzhou, Guangdong, China

Site Status

NanFang Hospital

Guangzhou, Guangdong, China

Site Status

Jiangsu Provincial Hospital

Nanjing, Jiangsu, China

Site Status

The First Affiliated Hospital of Soochow University

Suzhou, Jiangsu, China

Site Status

The First Affiliated Hospital of Nanchang University

Nanchang, Jiangxi, China

Site Status

The Second Affiliated Hospital of Nanchang University

Nanchang, Jiangxi, China

Site Status

First Affiliated Hospital of Dalian Medical University

Dalian, Liaoning, China

Site Status

Qingdao Municipal Hospital

Qingdao, Shandong, China

Site Status

Shanghai East Hospital

Shanghai, Shanghai Municipality, China

Site Status

Shanxi Cardiovascular Hospital

Taiyuan, Shanxi, China

Site Status

Tianjin Chest Hospital

Tianjin, Tianjin Municipality, China

Site Status

Tianjin Medical University General Hospital

Tianjin, Tianjin Municipality, China

Site Status

The Second Affiliated Hospital of Zhejiang University

Hangzhou, Zhejiang, China

Site Status

Sir Rung Rung Shaw Hospital, Zhejiang University School Of Medicine

Hangzhou, Zhejiang, China

Site Status

The Affiliated Hospital Of Medical School Of Ningbo University

Ningbo, Zhejiang, China

Site Status

Countries

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China

Central Contacts

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Yunlong Xia, Ph.D

Role: CONTACT

+86 18098875555

Chengming Ma, MD

Role: CONTACT

+86 18098875759

Facility Contacts

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Hao Su

Role: primary

+86 13205517890

Yumei Xue

Role: primary

+86 13570082363

Yuegang Wang

Role: primary

+86 13725265686

Minglong Chen

Role: primary

+86 13809000791

Tingbo Jiang

Role: primary

+86 18906201122

Ran Yin

Role: primary

+86 18679133150

Qi Chen

Role: primary

+86 13330087693

Xiaomeng Yin, Ph.D

Role: primary

+86 18098875778

Bingong Li

Role: primary

+86 17669657168

Zhigang Zhang

Role: primary

+86 18221885011

Haixiong Wang

Role: primary

+86 15003433600

Fengmin Lu

Role: primary

+86 13902114455

Heng Cai

Role: primary

+86 13821378394

Yaping Wang

Role: primary

+86 13805725837

Sheng Xia

Role: primary

+86 13857158757

Huimin Chu

Role: primary

+86 13566336742

References

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Grimaldi M, Quadrini F, Caporusso N, Troisi F, Vitulano N, Delmonte V, Di Monaco A. Deep sedation protocol during atrial fibrillation ablation using a novel variable-loop biphasic pulsed field ablation catheter. Europace. 2023 Aug 2;25(9):euad222. doi: 10.1093/europace/euad222.

Reference Type BACKGROUND
PMID: 37470452 (View on PubMed)

Benzoni T, Agarwal A, Cascella M. Procedural Sedation. 2025 Mar 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK551685/

Reference Type BACKGROUND
PMID: 31869149 (View on PubMed)

Other Identifiers

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ChiCTR2500096790

Identifier Type: OTHER

Identifier Source: secondary_id

TEMP-000758

Identifier Type: -

Identifier Source: org_study_id

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