Anaesthesia use in catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies

Abstract

ObjectivesThis meta-analysis and systematic review seeks to compare both characteristic parameters and procedural outcomes of atrial fibrillation (AF) catheter ablation in patients under general anaesthesia (GA)/deep sedation and mild/moderate sedation.BackgroundCatheter ablation has become a widely applied intervention for treating symptomatic AF and arrhythmias that are refractory to medical therapy. It can be conducted through from mild sedation to GA.MethodsPubMed and Embase were searched up to July 2018 for randomised controlled trials, cohort and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or mild/moderate sedation. Nine studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger’s regression, respectively.ResultsOur meta-analysis found catheter AF ablation with GA/deep sedation to be associated with reduced risk of recurrence (RR: 0.79, 95% CI 0.56 to 1.13, p=0.20) and complications (RR: 0.95, 95% CI 0.64 to 1.42, p=0.82), though statistically insignificant. In terms of procedural parameters, there was no significant difference between the two groups for both procedural time (SMD: −0.13, 95% CI −0.90 to 0.63, p=0.74) and fluoroscopy time (SMD: −0.41, 95% CI −1.40 to 0.58, p=0.41). Univariate meta-regression did not reveal any covariates as a moderating factor for complication and recurrence risk.ConclusionApart from an increased likelihood of procedural success, ablation by GA/deep sedation was found to be non-significantly different from the mild/moderate sedation approach in both procedural parameters and outcome measures.

Deep sedation with propofol in patients undergoing left atrial ablation procedures—Is it safe?

“…Compared to conscious sedation with fentanyl/midazolam, deep sedation with propofol might lead to higher ablation accuracy and is more comfortable for the patient. In 2019, Li and colleagues 3 indicated in a meta-analysis of 9 studies that catheter ablation under general anesthesia/deep sedation contains a higher likelihood of procedural success compared to conscious sedation. In 2011, Di Biase and colleagues 27 reported on a total of 257 AF patients undergoing catheter ablation with either conscious sedation (fentanyl/midazolam) or general anesthesia.…”

“…As a conclusion, general anesthesia/deep sedation likely reduces the prevalence of PV reconnection due to better catheter stability and a lower risk of tissue edema. Deep sedation with propofol has therefore been suggested as favorable anesthetic technique for catheter ablation in several studies [3,22].…”

“…(1) general anesthesia with endotracheal intubation, (2) deep sedation with propofol/midazolam or (3) moderate/conscious sedation with fentanyl or midazolam [3].…”

“… 2 Currently, ablation procedures are generally conducted in 3 settings: (1) general anesthesia with endotracheal intubation, (2) deep sedation with propofol/midazolam, or (3) moderate/conscious sedation with fentanyl or midazolam. 3 Several trials have shown that general anesthesia/deep sedation has a major impact on procedural success. For patients with AF undergoing pulmonary vein isolation, administration of general anesthesia increases safety and efficacy of the procedure and lowers rate of reconnections.…”

The Evaluation of Childhood Foods and Infant Formula Exposure to Furan, Chloropropanols and Acrylamide Contamination by Food Processing

“…On the other hand, there is not a clear consensus on the relationship between AA and cancer yet. Whereas, some studies reveal that AA increases the risk of contracting ovarian cancer [62], lung cancer [63] and the cancers related to digestive and respiratory systems [64], some other studies determine that AA has no positive relationship with several types of cancer [65][66][67]. However, IARC classifies AA as a probable human carcinogen (group 2A) [68].…”