Comparative Outcomes of Deep Sedation Versus General Anesthesia in Cryoablation for Atrial Fibrillation: Insights From the Korean Heart Rhythm Society Cryoablation Registry

BACKGROUND AND OBJECTIVES: The optimal sedation strategy for cryoablation in atrial fibrillation (AF) remains uncertain. We aimed to compare the safety and efficacy outcomes between deep sedation (DS) and general anesthesia (GA) in patients undergoing cryoablation. METHODS: We analyzed 2,068 patients from the Korean Heart Rhythm Society Cryoablation Registry who underwent cryoablation for AF between 2018 and 2022. Patients were grouped based on anesthesia method: DS (n=1,390) and GA (n=678). Propensity score matching (1:1) was performed to adjust for baseline differences. The primary outcomes included any recurrence of atrial tachyarrhythmias (ATs) after a 3 month blanking period and procedure-related major complications. RESULTS: The study included 2,068 patients (average age: 61.7±9.7 years; 76.3% male; 57.9% with persistent AF). In the matched cohort, AT recurrence rates were comparable between DS and GA groups (47.1% [n=220] vs. 53.1% [n=225]; p=0.99) during a mean follow-up of 1.2 years. The incidence of major complications was also similar between groups both before (2.8% [n=39] vs. 2.4% [n=16]; p=0.66) and after matching (2.3% [n=15] vs. 2.1% [n=14]; p=1.00). Subgroup analysis based on body mass index (≥30 vs. <30) revealed no significant differences in efficacy and safety outcomes between the DS and GA groups. CONCLUSIONS: DS provides a comparable safety and efficacy profile to GA for cryoablation in patients with AF. These findings support the use of DS as a feasible and practical alternative to GA in routine clinical practice.