Key result
Monitored anesthesia care shows similar drug-free sinus rhythm rates to general anesthesia for AF ablation.
Why the study?
Monitored anesthesia care and general anesthesia are both used during catheter ablation of AF, but each has advantages and disadvantages and the optimal approach has not been well established.
Does monitored anesthesia care compared to general anesthesia improve clinical outcomes, safety, or cost in patients undergoing a first catheter ablation for atrial fibrillation?
Observational (n=810)
Does monitored anesthesia care compared to general anesthesia improve clinical outcomes, safety, or cost in patients undergoing a first catheter ablation for atrial fibrillation?
Absolute Event Rate: 51% vs 47%
p-value: p=0.28
Monitored anesthesia care and general anesthesia offer similar long-term efficacy and safety for atrial fibrillation catheter ablation, though general anesthesia is associated with slightly higher costs and shorter ablation times.
Supports either anesthesia approach for AF ablation; leaves open whether randomized trials will clarify cost or procedural differences.
INTRODUCTION: Monitored anesthesia care (MAC) or general anesthesia (GA) can be used during catheter ablation (CA) of atrial fibrillation (AF). However, each approach may have advantages and disadvantages with variability in operator preferences. The optimal approach has not been well established. The purpose of this study was to compare procedural efficacy, safety, clinical outcomes, and cost of CA for AF performed with MAC versus GA. METHODS: The study population consisted of 810 consecutive patients (mean age: 63 ± 10 years, paroxysmal AF: 48%) who underwent a first CA for AF. All patients completed a preprocedural evaluation by the anesthesiologists. Among the 810 patients, MAC was used in 534 (66%) and GA in 276 (34%). Ten patients (1.5%) had to convert to GA during the CA. RESULTS: Although the total anesthesia care was longer with GA particularly in patients with persistent AF, CA was shorter by 5 min with GA than MAC (p < 0.01). Prevalence of perioperative complications was similar between the two groups (4% vs. 4%, p = 0.89). There was no atrioesophageal fistula with either approach. GA was associated with a small, ~7% increase in total charges due to longer anesthesia care. During 43 ± 17 months of follow-up after a single ablation procedure, 271/534 patients (51%) in the MAC and 129/276 (47%) patients in the GA groups were in sinus rhythm without concomitant antiarrhythmic drug therapy (p = 0.28). CONCLUSION: With the participation of an anesthesiologist, and proper preoperative assessment, CA of AF using GA or MAC has similar efficacy and safety.
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Yokokawa et al. (2022) conducted an observational in Atrial fibrillation (n=810). Monitored anesthesia care (MAC) vs. General anesthesia (GA) was evaluated on Sinus rhythm without concomitant antiarrhythmic drug therapy (p=0.28). Monitored anesthesia care and general anesthesia during catheter ablation for atrial fibrillation had similar rates of sinus rhythm without antiarrhythmic drugs (51% vs 47%, p=0.28).
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