The efficacy of general anesthesia during pulmonary vein isolation compared with conscious sedation

Background Catheter ablation (RFA) is significantly more effective in terms of arrhythmia recurrence rate than antiarrhythmic medication. For the duration of the procedure, the patient needs to remain motionless on the operation table. General anesthesia (GA) is widely used during atrial fibrillation (AF) ablation in all over the world, however RFA of AF is performed under conscious sedation (CS) in the most centers in Japan. It remains controversial whether cardiac anesthesiologists are best suited to manage anesthesia in the electrophysiology lab. Objective The aim of this study was to report the efficacy and safety of GA during AF ablation. Methods 297 patients (67.3±11.7 years, 208 men, 128 paroxysmal, mean follow up 443 days±306) with AF undergoing RFA in our department from January 2018 to December 2021 were retrospectively analyzed. 113 assigned to the GA group, 184 patients to the CS group. The primary efficacy end point was radiofrequency time, ablation index, force time integral. The secondary end points defined AF recurrence and the complications. Result There was no difference in the baseline characteristics between the two groups. There was no difference between groups in AF recurrence (22.1% vs. 14.1%, P=0.103) and complications.However, Patients in GA had shorter radiofrequency times (66.9±3.7 minute vs 79.0±2.9 minutes P=0.01)Ablation index (376±18.6 vs 371±22.6 P Conclusion General anesthesia is superior to conscious sedation with shorter radiofrequency times and higher than Force time integral, ablation index. Moreover, it is not inferior in regard to arrhythmia recurrence or complication rates of catheter ablation of atrial fibrillation. Funding Acknowledgement Type of funding sources: None.