Key result
Conscious sedation matches general anesthesia for 12-month arrhythmia recurrence despite longer procedure times.
Why the study?
The influence of general anesthesia versus conscious sedation on procedural characteristics and ablation outcome in paroxysmal AF patients using ICE and elimination of adenosine-mediated dormant conduction is not entirely known.
RCT (n=150)
Open-label
1:1
No
Absolute Event Rate: 31.5% vs 28.6%
p-value: p=0.695
Conscious sedation may be noninferior despite longer procedures; hypothesis-generating and should not yet change practice.
BACKGROUND: Catheter ablation of paroxysmal atrial fibrillation (AF) can be performed under general anesthesia or conscious sedation. The influence of type of anesthesiology care on procedural characteristics and ablation outcome in patients in whom intracardiac echocardiography (ICE) and elimination of adenosine-mediated dormant conduction (DC) is used is not entirely known. METHODS: 150 patients with paroxysmal AF were randomized to point-by-point radiofrequency catheter isolation of pulmonary veins (PVI) under general anesthesia (n=77) or conscious sedation (n=73). Adenosine-mediated dormant conduction was eliminated in all patients. Antiarrhythmic medication was discontinued after PVI. During twelve months of follow-up, all patients underwent four times 7-day ECG monitorings. RESULTS: There was no difference between groups in AF recurrence (28.6% vs. 31.5%, P=0.695). Patients in conscious sedation had longer procedure times (160 ± 32.1 vs. 132 ± 31.5 min, P<0.001), longer RF energy application times (40 ± 15 vs. 29 ± 11 min, P<0.001) and longer fluoroscopy times (6.2 min ± 5.3 vs. 4.3 min ± 2.2, P<0.001) with similar complication rates. CONCLUSION: Conscious sedation is not inferior to general anesthesia in regard to arrhythmia recurrence or complication rates of catheter ablation of paroxysmal atrial fibrillation. However, it is associated with longer procedure times, longer time of radiofrequency energy application and longer fluoroscopy times.
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Moravec et al. (2020) conducted an RCT in Paroxysmal atrial fibrillation (n=150). Conscious sedation vs. General anesthesia was evaluated on Arrhythmia recurrence rate twelve months after catheter ablation (p=0.695). Conscious sedation was not inferior to general anesthesia regarding arrhythmia recurrence at 12 months (31.5% vs 28.6%, p=0.695), though it resulted in significantly longer procedure times.
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