Relationship between coughing and bispectral index-guided sedation during pulsed field ablation for atrial fibrillation and its impact on mid-term outcomes.

Background: Coughing can occur during pulsed field ablation (PFA) for pulmonary vein (PV) isolation (PVI) of atrial fibrillation (AF) under deep sedation, and the bispectral index (BIS) is commonly used to monitor sedation depth. Objective: We aimed to investigate the relationship between coughing and BIS-guided sedation depth during PFA-based PVI and to evaluate the impact of coughing on clinical outcomes after AF catheter ablation. Methods: We retrospectively studied 198 consecutive patients undergoing an initial AF catheter ablation procedure using a 31-mm pentaspline PFA catheter under deep sedation. The BIS value before PFA for each PV, maximum BIS value among all PVs for each patient, and the presence or absence of coughing were assessed. Results: Coughing occurred in 260 PVs (32.8%) among 95 patients (48.0%). The incidence of coughing at maximum BIS <40, 40-70, and >70 was 0%, 37.2%, and 55.5%, respectively ( Conclusion: Coughing during pentaspline PFA catheter-based PVI under deep sedation was associated with higher BIS values, indicating lighter sedation, but had no adverse effect on the mid-term outcomes after the ablation procedure.