Association of Anesthesia Modality With Procedural Parameters and Clinical Outcomes in PVI for Atrial Fibrillation

BACKGROUND: Pulmonary vein isolation (PVI) for atrial fibrillation (AF) is performed under general anesthesia (GA) or conscious sedation (CS). Prior studies have linked anesthesia type to postoperative recurrence and catheter metrics, but not to catheter swing, interlesion distance (ILD), or acute pulmonary vein reconnection. We assessed how GA versus CS relates to intraoperative catheter stability, lesion continuity, and clinical outcomes. METHODS: This retrospective study included 147 patients undergoing first-time PVI (97 under GA, 50 under CS). We evaluated and compared catheter swing, contact force (CF), ablation index (AI), ILD, acute pulmonary vein reconnection, and 12-month recurrence between groups. RESULTS: Catheter swing (all segments p < 0.001), ILD (all segments p < 0.001), and acute pulmonary vein reconnection (20.6% vs. 54.0%, p < 0.001) were significantly lower in the GA group, which was associated with a higher postoperative success rate (12-month recurrence: 23.7% vs. 44.0%, p = 0.007). Anesthesia type was significantly associated with both acute pulmonary vein reconnection (OR 0.22, p < 0.001) and postoperative success (12-month OR 0.40, p = 0.013). Furthermore, catheter swing was significantly associated with acute pulmonary vein reconnection (OR 1.16, p < 0.001), which served as a crucial mediator between anesthesia strategy and overall postoperative success. CONCLUSIONS: In this retrospective cohort, GA was associated with reduced catheter swing, shorter ILD, and lower acute pulmonary vein reconnection compared to CS. Acute reconnection significantly mediated the association with 12-month freedom from AF. These findings suggest that GA may facilitate more durable lesion formation during PVI.