General anesthesia is not superior to sedation in clinical outcome and cost‐effectiveness for ablation of persistent atrial fibrillation

Abstract

Background The strategy of anesthesia used during ablation of atrial fibrillation (AF) remains controversial. This study aimed to compare sedation with general anesthesia (GA) for catheter ablation of AF. Hypothesis The presence of AF is associated with an increased risk of stroke and heart failure and decreased quality of life and survival. Methods We carried out a retrospective single‐centered study with 351 patients undergoing the first ablation procedure for AF under sedation or GA. The main outcome was freedom from recurrence of AF at 1 year. The total time of staying at the ablation laboratory and procedure cost were also calculated. Results Freedom from atrial arrhythmia and ablation time did not differ between AF patients under sedation and GA (77.9% vs 79.9% and 42.27 ± 9.84 minutes vs 41.51 ± 9.27 minutes, respectively), while the total procedure time and cost were lower in patients who underwent sedation than GA (171.39 ± 45.09 minutes vs 202.92 ± 43.85 and 8.00 ± 7.02 CNY vs 8.79 ± 11.63 CNY, respectively). Conclusion GA is not superior to sedation, in terms of ablation time and freedom from atrial arrhythmia at 1 year, whereas patients with GA had more anesthesia time and procedure cost than sedation.

Comparison of the Different Anesthesia Strategies for Atrial Fibrillation Catheter Ablation: A Systematic Review and Meta-Analysis

“…In addition, three studies published too long ago were excluded because ablation techniques and materials have changed and lack guidance for current clinical practice. The remaining 10 studies, comprising two RCTs [ 22 , 23 ] and 8 observational studies [ 13 – 15 , 17 , 24 – 27 ] satisfied the inclusion criteria and were eventually included in this meta-analysis. The literature search was conducted by two independent researchers (NP and JG).…”

“…CA of AF can be performed either under different anesthesia methods, but it is still controversial [ 16 , 24 , 28 ]. This meta-analysis systematically compared the clinical benefits and safety of GA/deep sedation and CS by procedural time, recurrence rate, and adverse event risk.…”

“…Of note, there was no significant difference in total procedural time, which meant the additional time caused by the anesthesia factor may have accounted for the time in this discrepancy. According to previous studies reported, it may be due to the longer anesthesia induction and recovery time [ 24 ]. There was no statistical difference in the fluoroscopy time between the two groups after quantitative synthesis.…”

“…Additionally, heterogeneity was high in all operative time parameters, which should be noted and discussed. For example, Wang's study [ 24 ] showed that the CS group had shorter procedural time, while Moravec's study [ 23 ] favored GA/deep sedation. According to check articles' descriptions, we did not find significant differences among studies.…”

Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea

“…The substantial deep negative intrathoracic pressure during obstructive apnea may lead to air embolization through the blood access sheath 46 . Although the effectiveness of catheter ablation under general anesthesia has been reported, 47 general anesthesia is not widely performed in Japan because of the total time, cost, and insurance concerns associated with the procedure 48 . The J‐CARAF study revealed that only 2.9% of the total 10,795 ablation procedures were performed under general anesthesia 49 .…”