COnventional vs. Optimized PERiprocedural Analgosedation vs. Total IntraVEnous Anesthesia for Pulsed-Field Ablation: a Three-Arm Randomized Controlled Trial (COOPERATIVE-PFA).
Circulation April 27, 2025 Veronika Sochorová, Veronika Kunštátová, Pavel OsmanČík et al. 7 citations
For pulsed-field ablation of atrial fibrillation, a sedation regimen combining remimazolam and ketamine (deep analgosedation) caused fewer breathing and blood-pressure complications than standard propofol-based approaches. In a randomized comparison of 127 patients, the composite of hypoxemia, hypotension, or hypertension requiring intervention occurred in 27.9% of those receiving remimazolam-ketamine, versus 85.7% with intermittent propofol-opioid boluses and 66.7% with propofol-opioid total intravenous anesthesia. Hypoxemia drove events in the propofol-bolus group (100% of those with the primary endpoint), while hypotension dominated in the total-intravenous-anesthesia group (100%). Procedure times, serious adverse events, and patient satisfaction did not differ among the three regimens. Remimazolam-ketamine deep analgosedation offered the safest profile for these procedures.