Hypnotic communication in interventional electrophysiology procedures in the COVID-19 period

Background: Hypnotic communication is a validated technique for reducing procedural anxiety and pain. The aim of our work was to evaluate the additional utility of hypnotic communication during catheter ablation procedures in the COVID-19 period. Materials and Methods: Sixteen consecutive patients undergoing electrophysiological study and catheter ablation underwent: 8 to standard sedation procedure (Group B) and 8 to this with the addition of hypnotic communication (Group A). In these two groups, we measured and compared preprocedure and intraprocedure anxiety, compliance to the procedure, perceived pain, use of drugs, the procedural time perceived by the patient compared to real time in minutes, and radiological exposure, using validated scales. Results: Hypnotic communication resulted in a significant reduction in anxiety during the procedure (Group A: 1.1 ± 0.6 vs. Group B: 3.4 ± 2; P = 0.003); better procedural compliance (Group A: 4.8 ± 0.5 vs. Group B: 3.7 ± 0.8; P = 0.002) and showed a trend toward a reduction in procedural pain (Group A: 2.4 ± 2 vs. Group B: 4.3 ± 1.8; P = 0.08) compared to standard sedation. Midazolam was not used in Group A, while an average of 3 ± 1.3 mg was used in Group B. The use of local anesthetic and Fentanest was comparable. The real procedural durations (Group A: 167.5 ± 30.1 vs. Group B: 150 ± 27.8 min; P = not significant) and perceived (Group A: 78.8 ± 15.5 vs. Group B: 86.3 ± 29.9 min; P = not significant) and the difference between these was also comparable. The radiological exposure was 74.4 ± 65.5 s in Group A and 118 ± 119 s in Group B (P = not significant). There were no complications in the two groups. Conclusions: Hypnotic communication as an additional strategy during electrophysiological interventional procedures has made possible to eliminate the use of midazolam and reduce anxiety during the procedure, but above all, it has improved the patient's compliance with the procedure compared to traditional sedation approach.