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

Abstract

Objectives: This 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.

Background: Catheter 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.

Methods: PubMed 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.

Results: Our 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.

Conclusion: Apart 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.

Keywords: arrhythmia; atrial fibrillation; general anesthesia; sedation.

Figure 3

Trim-and-fill funnel plots with Egger’s regression test of (A) mean procedural time, (B) mean fluoroscopy time, (C) recurrence, (D) complications comparing between GA/deep sedation and mild/moderate sedation in patients undergoing AF ablation. AF, atrial fibrillation; GA, general anaesthesia.

Figure 1

PRISMA flow diagram for the study selection process. AF, atrial fibrillation; GA, general anaesthesia; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Forest plots comparing (A) mean procedural time of arrhythmic ablation and (B) mean fluoroscopy time between the GA/deep sedation and mild/moderate sedation group. GA, general anaesthesia.

Figure 4

(A) Forest plots comparing procedural success rates of AF ablation between the GA/deep sedation and mild/moderate sedation group. (B) Forest plots comparing recurrence rates post-AF ablation between the GA/sedation and mild/moderate sedation group. (C) Forest plots comparing complication rates post-AF ablation between the GA/sedation and mild/moderate sedation group. AF, atrial fibrillation; GA, general anaesthesia.