Safety and 3-year procedural outcomes of a physician-administered conscious sedation (PACS) approach for ventricular tachycardia ablation

Abstract Background Ventricular Tachycardia (VT) ablation has been shown to reduce the risk of recurrent ventricular arrhythmias and may provide a mortality benefit. (1, 2) In patients with underlying cardiomyopathy, this procedure is frequently performed with general anaesthesia or deep sedation with anaesthetic support. There is limited data exploring the safety and efficacy of performing structural heart disease (SHD) VT ablation with a conscious sedation approach. This approach may have advantages in both procedural safety and long-term outcomes. Purpose To assess safety and long-term procedural outcomes of SHD VT ablation performed with a physician-administered conscious sedation (PACS) approach. Methods All structural heart disease VT ablation procedures performed with PACS over 6 years, between January 2018 and January 2024, at our institution were analysed. Results 148 patients (70±11 years, 18 female) underwent SHD VT ablation with the PACS approach. 123 patients (83%) had ischaemic cardiomyopathy and mean left ventricular ejection fraction was 35.0±12.6%. Baseline and procedural characteristics are summarised in Table 1. The average procedural dose of midazolam was 3.7±2.9 mg and fentanyl was 83.5±60.2 micrograms. The 30-day procedural complication rate was 3.4% (n=5). At 12-month follow-up (n=125) 90% of patients were free from implantable cardioverter defibrillator (ICD) shocks and 83% were free from anti-tachycardia pacing (ATP) therapy. With a median follow-up of 30 months, freedom from ICD shocks and ATP therapy was 84% and 76%, respectively (Figure 1). Average duration to first ICD shock (n=20) was 465±617 days and 291±396 to first ATP therapy (n=30). Conclusion The PACS approach in performing SHD VT ablation is safe and results in a low rate of long-term recurrent ICD therapies. These findings support the use of a PACS approach when performing VT ablation. Further investigation to determine whether improved long-term outcomes are related to type of anaesthesia/sedation are ongoing.Table 1 Figure 1