Conscious sedation versus general anesthesia for transesophageal echocardiography guidance of percutaneous left atrial appendage occlusion

OBJECTIVES: This study sought to compare the transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) procedures under general anesthesia with conscious sedation. BACKGROUND: In the expanding field of LAAO procedures, developing minimalistic approaches that eliminate the need for general anesthesia is crucial. Conscious sedation is spreading as an alternative for performing TEE-monitored LAAO procedures. METHODS: For this study, patients enrolled in the registry who underwent LAAO under conscious sedation were compared with those who received general anesthesia. One-to-one propensity score matching was used to balance baseline characteristics between groups. Outcomes assessed included technical success, procedural success, and clinical follow-up. RESULTS: A total of 231 patients were included. After adjustment, 99 patched pairs treated with LAAO using general anesthesia and conscious sedation were compared. The technical success did not differ between general anesthesia and conscious sedation patients [98 versus 99%; P = 0.612; hazard ratio 1.68; 95% confidence interval (CI): 0.22-18.64]. The procedural success, defined as technical success in the absence of in-hospital device or procedure-related clinical events, was comparable between the two groups (95 versus 97%; P = 0721; hazard ratio 1.70; 95% CI: 0.32-11.24). No statistically significant differences were found for all procedural complications assessed, including death, neurological events, pericardial effusion, device embolization, systemic arteria embolization, and major bleeding. Also, clinical adverse events during follow-up were comparable between general anesthesia and conscious sedation procedures. CONCLUSION: This study shows that LAAO can be performed with equivalent outcomes under either general anesthesia or conscious sedation.