Key result
General anaesthesia/deep sedation for atrial fibrillation catheter ablation did not significantly reduce recurrence risk compared to mild/moderate sedation (RR 0.79; 95% CI 0.56-1.13; p=0.20).
Why the study?
Catheter ablation for symptomatic or drug-refractory AF can be performed using mild sedation to GA, but characteristic parameters and procedural outcomes between these anaesthetic strategies required systematic comparison.
Does general anaesthesia or deep sedation improve outcomes or reduce complications compared to mild/moderate sedation in patients undergoing catheter ablation for atrial fibrillation?
Meta-Analysis
Does general anaesthesia or deep sedation improve outcomes or reduce complications compared to mild/moderate sedation in patients undergoing catheter ablation for atrial fibrillation?
Relative Risk: 0.79 (95% CI 0.56–1.13)
p-value: p=0.20
General anaesthesia or deep sedation for atrial fibrillation ablation does not significantly differ from mild/moderate sedation in terms of recurrence, complications, or procedural times.
GA/deep sedation boosts procedural success in AF ablation; observational data leave open effects on recurrence or complications, warranting RCTs.
Objectives This meta-analysis and systematic review seeks to compare both characteristic parameters and procedural outcomes of atrial fibrillation (AF) catheter ablation in patients under general anaesthesia (GA)/deep sedation and mild/moderate sedation. Background Catheter ablation has become a widely applied intervention for treating symptomatic AF and arrhythmias that are refractory to medical therapy. It can be conducted through from mild sedation to GA. Methods PubMed and Embase were searched up to July 2018 for randomised controlled trials, cohort and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or mild/moderate sedation. Nine studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger’s regression, respectively. Results Our meta-analysis found catheter AF ablation with GA/deep sedation to be associated with reduced risk of recurrence (RR: 0.79, 95% CI 0.56 to 1.13, p=0.20) and complications (RR: 0.95, 95% CI 0.64 to 1.42, p=0.82), though statistically insignificant. In terms of procedural parameters, there was no significant difference between the two groups for both procedural time (SMD: −0.13, 95% CI −0.90 to 0.63, p=0.74) and fluoroscopy time (SMD: −0.41, 95% CI −1.40 to 0.58, p=0.41). Univariate meta-regression did not reveal any covariates as a moderating factor for complication and recurrence risk. Conclusion Apart from an increased likelihood of procedural success, ablation by GA/deep sedation was found to be non-significantly different from the mild/moderate sedation approach in both procedural parameters and outcome measures.
No takes yet. Share an insight, caveat, or question.
Li et al. (2019) conducted a meta-analysis in Atrial fibrillation. General anaesthesia/deep sedation vs. Mild/moderate sedation was evaluated on Recurrence (RR 0.79, 95% CI 0.56 to 1.13, p=0.20). General anaesthesia/deep sedation for atrial fibrillation catheter ablation did not significantly reduce recurrence risk compared to mild/moderate sedation (RR 0.79; 95% CI 0.56-1.13; p=0.20).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: