Patients undergoing electrophysiological mapping, which is a catheter-based procedure for ventricular arrhythmias, or catheter ablation for atrial fibrillation are required to lie motionless on the table for several hours, and repeated stimuli from ablation are sometimes painful. For these reasons, patients usually need deep sedation or general anesthesia.

Sbrana et al. [9] described a case series of patients who underwent catheter ablation for atrial fibrillation. In these patients, NIV and deep sedation were started after trans-septal puncture. NIV was performed through a latex-free total face mask (Respironic®, Murrysville, PA, USA) (Fig. 70.3) connected to a Garbin ventilator (Linde Inc., Herrsching, Germany) in spontaneous/temporized mode, applying incorporated algorithms to improve patient-ventilator synchrony by adjusting to changing breathing patterns and dynamic leaks. During the procedure, in addition to routine monitoring, serial arterial blood gas analyses and invasive arterial pressure monitoring were performed. IPAP, expiratory positive airway pressure (EPAP), and respiratory rate were modified according to the clinical response, including patient tolerance, to obtain an exhaled tidal volume of 6–8 ml/kg; the FiO₂ requirement to maintain SaO₂ above 92 % was ≤0.4.

In this group of patients, no respiratory complications, problems due to gastric distention, issues related to the ventilation interface (mask), NIV discomfort, or significant hemodynamic effects due to positive pressure ventilation were reported. Furthermore, these patients maintained (although with respiratory parameters in the physiological range) better arterial blood gases and acid–base balance compared with a deep sedation group without NIV [10]. Finally, a continuous monitoring of tidal volume, air leak, and actual minute ventilation during the entire procedure contributed to patient safety.