Obstructive respiratory events during procedural sedation and analgesia: Another WHY to routinely screen for sleep apnea before catheter ablation of atrial fibrillation

Increasing number of complex catheter ablation (CCA) procedures for the treatment of atrial fibrillation (AF) by radiofrequency catheter or cryo-balloon based techniques are performed under procedural sedation and analgesia (PSA). Compared to general anaesthesia, moderate PSA during CCA for AF is associated with shorter total laboratory and turn-over times without compromising the success rates [1]. A short procedure time and a fast recovery from PSA allows performing CCAs as one day case procedures, which is now implemented in multiple high throughput centers [1]. Although the use of respiratory depressants (e.g. midazolam, opioids) during PSA increases the risk of obstructive respiratory events due to collapse of the upper airways [2], [3], real-time monitoring of upper airway obstructions during CCAs has not been widely established.