effect of remifentanil-midazolam on electrophysiological properties of normal conduction system and accessory pathways in wolff-parkinson-white syndrome in cardiac catheterization laboratories

ABSTRACT

The effects of remifentanil midazolam sedation upon the electrophysiologic [EP] properties of normal atrioventricular [A-V] and accessory pathway [AP] conduction were studied in twenty patients with Wolff-Parkinson-White [WPW] syndrome during accessory pathway ablation in cardiac catheterization laboratories [CCL] The presence of an AP was confirmed by baseline EP studies. Sedation was induced with remifentanil [0.5mcg/kg] over 30-60 second and midazolam [0.1 mg /kg] and maintained with remifentanil infusion [0.025-0.05mcg/kg/min]. A baseline EP study was performed which consisted of effective refractory period [ERP] and shortest cycle length [SCC] measurement during antegrade conduction in the normal A-V pathway arid AP, as well as during retrograde conduction in the AP. Comparison with baseline EP studies indicated that the administration of remifentanil-midazolam sedation had no effect upon conduction or ERP in either pathways. Haemodynamic stability and no significant blood gases changes oct urred throughout the ablation procedure with no development of dysrrhythmia. We conclude that a combination of remifentanil-midazolarn is suitable for sedation in patients undergoing ablative procedures for accessory pathways in cardiac catheterization laboratories [CCL]