Deep sedation during pulsed field ablation for atrial fibrillation resulted in similar 1-year freedom from recurrent arrhythmia compared to general anesthesia (73.8% vs 74.8%; p=0.87).
Observational (n=1,233)
Yes
Does deep sedation maintain efficacy and safety compared to general anesthesia in patients undergoing pulsed field ablation for atrial fibrillation?
Deep sedation during pulsed field ablation for atrial fibrillation offers shorter procedure and fluoroscopy times with comparable 1-year safety and efficacy to general anesthesia.
Absolute Event Rate: 73.8% vs 74.8%
p-value: p=0.87
BACKGROUND: With the introduction of pulsed field ablation (PFA) to treat atrial fibrillation (AF), there is interest in studying workflow and sedation strategies to optimize integration into clinical practice. This sub-analysis characterizes early real-world use of general anesthesia versus deep sedation during AF ablation using the pentaspline PFA catheter. METHODS: EU-PORIA is an all-comer AF registry enrolling consecutive patients at seven high-volume centers in Europe. Patients were treated based on institutional standard-of-care. During follow-up, any episode of atrial tachycardia (AT) or AF >30s was considered an arrhythmia recurrence. RESULTS: EU-PORIA enrolled 1233 patients, of which 250 (20%) and 983 (80%) cases were performed using general anesthesia and deep sedation, respectively. Patients treated with general anesthesia were more often male and non-paroxysmal AF. In the general anesthesia group, 72% received pulmonary vein isolation (PVI)-only versus 90% in the deep sedation group (p<0.01), and 3D mapping was used in 60% of general anesthesia and 27% of deep sedation cases (p<0.01). Procedure and fluoroscopy times were shorter with deep sedation (5136-84 vs 7560-90 min; 138-19 vs 1915-26 min; p<0.01). There were no differences in the incidence of serious adverse events. At 1-year follow-up, 74.8% and 73.8% of patients in the general anesthesia and deep sedation groups, respectively, were free from recurrent AF/AT (p=0.87). CONCLUSION: AF ablation using deep sedation with the pentaspline PFA catheter demonstrated a safety and efficacy profile consistent with procedures performed under general anesthesia. This characterization of real-world use warrants further evaluation to understand optimal sedation strategies with PFA technologies.
Chun et al. (Sun,) conducted a observational in Atrial fibrillation (n=1,233). Deep sedation vs. General anesthesia was evaluated on Freedom from recurrent atrial fibrillation or atrial tachycardia >30s (p=0.87). Deep sedation during pulsed field ablation for atrial fibrillation resulted in similar 1-year freedom from recurrent arrhythmia compared to general anesthesia (73.8% vs 74.8%; p=0.87).