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

Abstract

Background. Catheter ablation has become a widely applied intervention for treating symptomatic atrial fibrillation (AF), which can be performed under general anesthesia (GA), deep sedation, or conscious sedation (CS). But the strategy of anesthesia remains controversial. Objectives. This systematic review and meta-analysis aims to compare the advantages of GA/deep sedation and CS in AF catheter ablation, including procedural parameters and clinical outcomes. Methods. PubMed, Embase, and the Cochrane Library were searched up to November 2021 for randomized controlled trials and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or CS. Ten studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies was evaluated by the I2 index and the Cochran Q test, respectively; sensitivity analysis including meta-regression was performed if heterogeneity was high. Publication bias was assessed using a funnel plot and Egger’ test. Results. This meta-analysis found GA/deep sedation to be associated with a lower recurrence rate of AF catheter ablation ( $p=0.03$ ). In terms of procedural parameters, there was no significant difference between the two groups for the procedural time ( $p=0.35$ ) and the fluoroscopy time ( $p=0.60$ ), while the ablation time was shorter in the GA/deep sedation group ( $p=0.008$ ). The total complication rate and the incidence of serious adverse events were statistically insignificant between the two groups ( $p=0.07$ and $p=0.94$ ). Meta-regression did not suggest any covariates as an influential factor for procedural parameters and clinical outcomes. Conclusion. GA/deep sedation may reduce the risk of recurrence after AF ablation without increasing the incidence of complications. GA/deep sedation shortens the ablation duration, although there is no statistical difference in other procedural parameters between GA/deep sedation and CS.