The importance of anaesthesia in atrial fibrillation ablation: Comparing conscious sedation with general anaesthesia

Abstract

Background: General anaesthesia (GA) for atrial fibrillation (AF) ablation is often preferred over conscious sedation (CS) to minimize patient discomfort and reduce the risk of map disruption from patient movement but may pose an additional risk to some patients with significant comorbidity or poor cardiac function.

Methods: We extracted data for 300 patients who underwent AF ablation between the years 2017 and 2019 and compared the outcomes of AF ablation with CS and GA.

Results: Compared to the GA group, patients were younger in the CS group (63 versus 66 years, p = 0.02), had less persistent AF (34% versus 46%, p = 0.048) and the left atrial dimension was smaller (41 versus 45 mm, p = 0.01). More patients had cryoballoon ablation (CBA) than radiofrequency (RFA) ablation in the CS than the GA group (88% CB with CS and 56% RF with GA, p < 0.01), frequency of ASA score 3-4 (higher anaesthetic risk) was less for CS than for GA (45% versus 75%, p < 0.01), and procedural duration was shorter for patients who had CS (110 versus 139 min, p < 0.001). Of the patients receiving CS, 127/182 (70%) were planned for same day discharge (SDD) and this occurred in 120 (94%) of those patients. There were no significant differences in complication rates between the groups (5.1% in GA and 6% in CS, p = 0.8). AF type was the only significant predictor of freedom from AF recurrence on multivariate analysis (HR 0.33, 0.13-0.82, p = 0.018).

Conclusion: In this study, the use of CS compared with GA for AF ablation was associated with similar outcomes and complication rates.

Keywords: Atrial fibrillation ablation; Conscious sedation; General anaesthesia.

Fig. 1

Survival free from AT recurrence comparing GA and CS group, denovo procedures.

Fig. 2

Survival free from AT recurrence comparing GA and CS in RFA group.

Fig. 3

Survival free from AT recurrence comparing GA and CS in CBA group.