Circular over-the-wire pulsed field ablation for atrial fibrillation: differences in outcomes between conscious sedation or general anesthesia

BACKGROUND: Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) is typically performed under general anesthesia (GA) due to patient discomfort and pain. However, procedures under GA require specialized personnel for airway management. PFA systems with suitable characteristics may enable PFA-procedures to be performed under bolus- administered conscious sedation (CS). OBJECTIVE: Assess the feasibility, safety, and efficacy of performing PVI with a circular-over-the-wire PFA catheter under CS, compared to GA. METHODS: We conducted a single-center registry study of atrial fibrillation (AF) patients undergoing an ablation with the circular over-the-wire PFA catheter, between January 29 and December 31, 2024, at the St. Antonius Hospital, The Netherlands. CS was used if no anesthesiology team was available. Endpoints included acute isolation of ablation targets, procedural characteristics and freedom from adverse events. RESULTS: The analysis included 174 consecutive patients (67.2% male, mean age 62.8 ± 9.3 years), with 62.1% having paroxysmal AF. GA was used in 132 patients (75.9%). There were no differences in baseline characteristics between the groups. Total number of applications was higher in the GA group: 33.0 [IQR 32.0; 36.0] vs. 32.0 [IQR 32.0; 33.0], p < 0.001. Median skin-to-skin procedural time was comparable between groups: GA 39.0 min [IQR 34.0;46.0] vs. CS 42.0 min [IQR 37.5; 46.0], P = N.S. Acute procedural efficacy was 100% in both groups. One patient in the GA group experienced a major bleeding complication. CONCLUSION: Conscious sedation offers an efficient and safe alternative to general anesthesia for patients undergoing a procedure with use of the circular over-the-wire PFA catheter.