Comparison of general anesthesia and deep sedation for complex atrial ablation procedures using a lattice-tip catheter with monopolar pulsed field and radiofrequency ablation

BACKGROUND: A dual-energy lattice-tip catheter with full 3D integration using monopolar pulsed field ablation (PFA) can result in significant skeletal muscle recruitment. It has therefore mainly been utilized under general anesthesia (GA), but procedures might also be possible using propofol-based deep sedation (DS). METHODS: Consecutive patients undergoing ablation of atrial fibrillation or left atrial flutter using the lattice-tip catheter were enrolled. The use of PFA and/or RFA was based on anatomical location. Procedural characteristics and outcomes were compared between patients with GA and those with DS. RESULTS: A total of 101 patients underwent ablation, 54% were treated under GA and 47% received DS (median age 69 years, 40% women, 85% redo-procedures). The arrhythmia subtypes were atrial fibrillation in 26%, left atrial flutter in 44%, and both in 31%. In addition to PVI, a total of 150 left atrial extra-PV lesion sets were performed, and CTI ablation in 59 patients. Median laboratory occupancy time was significantly shorter in the deep sedation group (GA 203 min [157-231] vs. DS 162 min [IQR 148-196], p = 0.003). No conversions from deep sedation to general anesthesia were required. Freedom from atrial arrhythmia recurrence was higher in the GA group (76% vs. 49% in the DS group, p = 0.038). After adjustment for confounders, the association attenuated but remained directionally consistent in favor of GA (HR 0.47 for recurrence, p = 0.061). CONCLUSIONS: Complex atrial ablation using a dual-energy lattice-tip catheter appears safe under both GA and DS. Despite higher baseline risk, GA patients had fewer arrhythmia recurrences at one year.