Author + information
- Received February 25, 2020
- Revision received May 6, 2020
- Accepted May 26, 2020
- Published online August 12, 2020.
- Rodrigue Garcia, MD, MSca,b,∗ (, )@RodrigueGarcia4,
- Claire Bouleti, MD, PhDa,b,c,
- Anthony Li, MDd,
- Denis Frasca, MD, PhDb,e,
- Sophia El Harrouchia,
- Julien Marechal, MDa,
- Pierre Roumegou, MDa,
- Pierre Corbi, MDb,f,
- Luc Christiaens, MDa,b,
- François Le Gal, MD, PhDa and
- Bruno Degand, MDa
- aCentre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
- bUniversité de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France
- cINSERM CIC 1402, Poitiers, France
- dCardiology Clinical Academic Group, St. George’s University of London, London, United Kingdom
- eCentre Hopsitalier Universitaire (CHU) Poitiers, Anesthesia and Intensive Care, Poitiers, France
- fCentre Hospitalier Universitaire (CHU) Poitiers, Department of Thoracic and Cardiovascular Surgery, Poitiers, France
- ↵∗Address for correspondence:
Dr. Rodrigue Garcia, Service de Cardiologie, Centre Cardiovasculaire, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France.
Objectives The aim of this study was to assess the superiority of hypnosis versus placebo on pain perception and morphine consumption during typical atrial flutter (AFL) ablation.
Background AFL ablation commonly requires intravenous opioid for analgesia, which can be associated with adverse outcomes. Hypnosis is an alternative technique with rising interest, but robust data in electrophysiological procedures are lacking.
Methods This single center, randomized controlled trial compared hypnosis and placebo during AFl ablation. In addition to the randomized intervention, all patients were treated according to the institution’s standard of care analgesia protocol (administration of 1 mg of intravenous morphine in case of self-reported pain ≥5 on an 11-point numeric rating scale or on demand). The primary endpoint was perceived pain quantified by patients using a visual analog scale.
Results Between October 2017 and September 2019, 113 patients (mean age 70 ± 12 years, 21% women) were randomized to hypnosis (n = 56) or placebo (n = 57). Mean pain score was 4.0 ± 2.2 in the hypnosis group versus 5.5 ± 1.8 in the placebo group (p < 0.001). Pain perception, assessed every 5 min during the whole procedure, was consistently lower in the hypnosis group. Patients’ sedation scores were also better in the hypnosis group than in the placebo group (8.3 ± 2.2 vs. 5.4 ± 2.5; p < 0.001). Finally, morphine requirements were significantly lower in the hypnosis group (1.3 ± 1.3 mg) compared with the placebo group (3.6 ± 1.8 mg; p < 0.001).
Conclusions In this first randomized trial, hypnosis during AFL ablation was superior to placebo for alleviating pain and reducing morphine consumption.
Dr. Garcia has received consulting fees from St. Jude Medical and Boston Scientific. Drs. Le Gal and Degand have received consulting fees from Sorin Group, St. Jude Medical, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 25, 2020.
- Revision received May 6, 2020.
- Accepted May 26, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.