Hypnosis for periprocedural analgesia during transcatheter pulsed field ablation of atrial fibrillation compared to conventional radiofrequency and very high power short duration ablation

Abstract Background Pulsed field ablation (PFA) has recently been presented as non-thermal energy modality applied for single-shot pulmonary vein isolation (PVI) in atrial fibrillation (AF) ablation. Hypnotic communication is a well-established therapeutic strategy for pain control during interventional procedure. Its role during AF ablation by PFA has not yet been established. Purpose We aimed to investigate the use of hypnotic communication during ablation of AF comparing 3 different energy modalities: PFA, conventional radiofrequency (RF) and very high power short duration (vHPSD). Methods Prospective, consecutive AF patients undergoing PVI with a pentaspline PFA catheter were compared to a retrospective RF and vHSPD cohort of the same timeframe. Study endpoints were the requirements of deep sedation or general anesthesia, pain killer drugs dose use, procedure complications and duration. Results A total of 30 AF ablation patients were included (PFA =10, vHPSD =10 and RF =10). Mean age was 59 ± 10.6, without significant difference between the study groups (p=0.81), 20 (68%) male patients, 24 (80%) paroxysmal AF. Hypnotic communication was effectively carried out in 8 out of 10 patients undergoing PFA and vHPSD ablation and 9 patients out of 10 undergoing conventional RF ablation. 5 patients required deep sedation by midazolam, ketamine and/or dexmedetomidine infusion. None patients required general anesthesia. Median dose of fentanyl used was 150 mcg (25-75% IQR 125-200 mcg), without significant difference between the study groups (p=0.84). No procedure related complication was observed. Procedural time was significant shorter in patients undergoing PFA ablation (mean time PFA 60.9 ± 13 min, vHPSD 90±12min, RF 101±31min, p =0.002). Conclusions Hypnotic communication during PFA ablation can be effectively performed as pain control strategy, without any significant difference with different thermal ablation strategies (vHSPD or RF ablation).