Back pain after atrial fibrillation ablation under propofol sedation with adaptive servo-ventilation: incidence, time course, efficacy of venous-closure devices, and related factors.

backgroundPostoperative pain is a frequent but underrecognized complication following atrial fibrillation (AF) ablation. Although AF ablation is increasingly performed worldwide, non-cardiac complications, particularly musculoskeletal pain such as back pain, remain insufficiently investigated. Post-ablation back pain is commonly attributed to prolonged and rigid bed rest required to achieve hemostasis at the femoral venous puncture site. Venous-closure devices have recently been introduced, enabling earlier ambulation and less restrictive bed rest. We hypothesized that venous-closure device use is associated with a lower incidence of post-ablation back pain.

methodsWe retrospectively analyzed 615 consecutive patients who underwent AF ablation under deep propofol sedation with adaptive servo-ventilation at a single tertiary center. Hemostasis was achieved by either prolonged manual compression requiring overnight bed rest (conventional compression group, n = 312) or a venous-closure device allowing earlier mobilization (device-utilized group, n = 303). The incidence, timing, and temporal course of post-ablation back pain were systematically assessed. Multivariable regression analyses were performed to identify independent factors associated with back pain.

resultsBack pain occurred in 52.6% of patients in the conventional compression group. In contrast, the device-utilized group experienced significantly shorter enforced bed rest (3.4 ± 0.7 h vs. 18.0 ± 2.2 h) and a markedly lower incidence of back pain (23.4% vs. 52.6%, p < 0.001). Although the overall temporal pattern of pain onset was similar between groups, the incidence of back pain from the initiation of bed rest through the following morning was consistently lower in patients treated with a venous-closure device. Multivariable analysis identified younger age, absence of intraoperative pentazocine, a prior history of back pain, and non-use of a venous-closure device as independent factors associated with post-ablation back pain.

conclusionsPost-ablation back pain occurred in nearly half of patients undergoing AF ablation with conventional manual compression. Venous-closure device use was independently associated with a substantially lower incidence of back pain, likely through earlier and less restrictive mobilization. Nevertheless, back pain persisted in approximately one-quarter of patients despite device use, indicating a need for additional preventive strategies.