Abstract | PURPOSE: METHODS: Consecutive patients undergoing catheter ablation for atrial fibrillation (AF) or ventricular tachycardia (VT) received continuous TCO(2) monitoring. Procedural evaluation of TCO(2) was performed concomitantly with point-of-care arterial blood gas testing. Endpoints included PCO(2) protocol feasibility, TCO(2)/PCO(2) agreement, and avoidance of hypercapnia-related procedural complications. RESULTS: Fifty patients [AF n = 36 (72 %), VT n = 14 (28 %)] underwent catheter ablation (mean 221.7 ± 57.0 min duration, median 41.4 ± 21.1 min fluoroscopy) in which 6.0 ± 2.6 mg midazolam and 449 ± 225.5 mcg of fentanyl were administered. Monitoring protocol implementation was feasible in 50/50 (100 %) cases. Protocol-driven anesthesia consultation avoided an unplanned intubation in 1 case (2 %) and there was only 1 unplanned intubation (2 %) for oxygen desaturation due to heart failure without hypercapnia during a VT ablation (TCO(2)/PCO(2) agreement <5 mmHg). There were no respiratory or pulseless electrical arrests (0 %) in the study. TCO(2) and PCO(2) correlated well (baseline: r = 0.75, p < 0.001; 1 h:r= 0.72, p < 0.001; 2 h: r = 0.55, p = 0.003; 3 h: r = 0.79, p = 0.02). However, desired agreement was lower than expected [baseline: 33/50 (66 %) < 5 mmHg, 48/50 (96 %) <10 mmHg; 1 h: 29/45 (64 %) < 5 mmHg, 39/45 (87 %) < 10 mmHg; 2 h: 14/26 (54 %) < 5 mmHg, 22/26 (85 %) < 10 mmHg; 3 h: 7/11 (64 %) < 5 mmHg, 10/11 (91 %) < 10 mmHg; >3 h: 1/3 (33 %) < 5 mmHg, 2/3 (66 %) < 10 mmHg]. CONCLUSION: Transcutaneous CO2 monitoring is feasible during complex catheter ablation and correlates with invasively obtained data. However, further development is needed to achieve the desired level of agreement.
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Authors | Daniel J Cantillon, Lisa M Keene, Ali Hakim, Stephanie Spencer, Jennifer Petro, Mary Ludvik, Dawn Schell |
Journal | Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
(J Interv Card Electrophysiol)
Vol. 43
Issue 3
Pg. 307-11
(Sep 2015)
ISSN: 1572-8595 [Electronic] Netherlands |
PMID | 25997689
(Publication Type: Clinical Study, Journal Article)
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Chemical References |
- Anesthetics
- Carbon Dioxide
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Topics |
- Anesthetics
(adverse effects)
- Blood Gas Monitoring, Transcutaneous
(methods)
- Carbon Dioxide
(blood)
- Catheter Ablation
(adverse effects, methods)
- Feasibility Studies
- Female
- Humans
- Hypercapnia
(blood, etiology, prevention & control)
- Male
- Middle Aged
- Monitoring, Intraoperative
(methods)
- Reproducibility of Results
- Sensitivity and Specificity
- Treatment Outcome
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