Dataset Information

General anaesthesia compared to conscious sedation for first time atrial fibrillation catheter ablation - a Danish nationwide cohort study.

ABSTRACT:

Background and aim

Catheter ablation (CA) is a well-established treatment option for atrial fibrillation (AF), where sedation and analgesia are pivotal for patient comfort and lesion formation. The impact of anaesthesia type on AF recurrence rates remains uncertain. This study aimed to examine AF recurrence rates depending on conscious sedation (CS) versus general anaesthesia (GA) during CA.

Methods

Utilizing nationwide data from The Danish healthcare registries, we conducted this cohort study involving adults (≥18 years) undergoing first-time CA for AF between 2010 and 2018. Patients were categorized by anaesthesia type (CS or GA), with the primary endpoint being AF recurrence, defined by a composite endpoint of either antiarrhythmic drugs (AAD) prescriptions, AF-related hospital admissions, electrical cardioversions, or AF re-ablation. The impact of anaesthesia type was evaluated using multivariable Cox proportional hazards analysis.

Results

The study cohort comprised 7,957 (6,421 CS and 1,536 GA) patients. Persistent AF, hypertension, and heart failure, as well as use of AAD were more prevalent in the GA group. Cumulative incidences of recurrent AF were higher in the CS group at one year (46% vs 37%) and at five years (68 % vs 63%). Multivariate analysis revealed CS as significantly associated with increased risk of AF recurrence at five-year follow-up (HR 1.26 (95% CI: 1.15-1.38)), consistent across paroxysmal and persistent AF subtypes.

Conclusions

This nationwide cohort study suggests a higher risk of AF recurrence with CS during CA compared to GA. These results advocate for considering GA as the preferred anaesthesia type for improved CA outcomes.

SUBMITTER: Da Riis-Vestergaard L

PROVIDER: S-EPMC11342248 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Publications

General anaesthesia compared to conscious sedation for first-time atrial fibrillation catheter ablation-a Danish nationwide cohort study.

Riis-Vestergaard Lise Da LD Tønnesen Jacob J Ruwald Martin H MH Zörner Christopher R CR Middelfart Charlotte C Hein Regitze R Johannessen Arne A Hansen Jim J Worck Rene Husted RH Gislason Gunnar G Hansen Morten Lock ML

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 20240801 8

<h4>Aims</h4>Catheter ablation (CA) is a well-established treatment option for atrial fibrillation (AF), where sedation and analgesia are pivotal for patient comfort and lesion formation. The impact of anaesthesia type on AF recurrence rates remains uncertain. This study aimed to examine AF recurrence rates depending on conscious sedation (CS) vs. general anaesthesia (GA) during CA.<h4>Methods and results</h4>Utilizing nationwide data from the Danish healthcare registries, we conducted this coho ...[more]

PMID: 39106218

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Project description:AF is a heterogeneous rhythm disorder that is related to a wide spectrum of etiologies and has broad clinical presentations. Mechanisms underlying AF are complex and remain incompletely understood despite extensive research. They associate interactions between triggers, substrate and modulators including ionic and anatomic remodeling, genetic predisposition and neuro-humoral contributors. The pulmonary veins play a key role in the pathogenesis of AF and their isolation is associated to high rates of AF freedom in patients with paroxysmal AF. However, ablation of persistent AF remains less effective, mainly limited by the difficulty to identify the sources sustaining AF. Many theories were advanced to explain the perpetuation of this form of AF, ranging from a single localized focal and reentrant source to diffuse bi-atrial multiple wavelets. Translating these mechanisms to the clinical practice remains challenging and limited by the spatio-temporal resolution of the mapping techniques. AF is driven by focal or reentrant activities that are initially clustered in a relatively limited atrial surface then disseminate everywhere in both atria. Evidence for structural remodeling, mainly represented by atrial fibrosis suggests that reentrant activities using anatomical substrate are the key mechanism sustaining AF. These reentries can be endocardial, epicardial, and intramural which makes them less accessible for mapping and for ablation. Subsequently, early interventions before irreversible remodeling are of major importance. Circumferential pulmonary vein isolation remains the cornerstone of the treatment of AF, regardless of the AF form and of the AF duration. No ablation strategy consistently demonstrated superiority to pulmonary vein isolation in preventing long term recurrences of atrial arrhythmias. Further research that allows accurate identification of the mechanisms underlying AF and efficient ablation should improve the results of PsAF ablation.