Anaesthesia use in catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies

LI, Ka Hou Christien, SANG, Tian, CHAN, Cheng, GONG, Mengqi, LIU, Yingzhi, JESUTHASAN, Aaron, LI, Guangping, LIU, Tong, LAM, Michael H S, WU, William KK, CHAN, Matthew T V, LIU, Fang-zhou, CHEN, Cheng, HO, Jeffery, XIA, Yunlong and TSE, Gary (2019). Anaesthesia use in catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies. Heart Asia, 11 (2), e011155.

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Link to published version:: https://doi.org/10.1136/heartasia-2018-011155
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    Abstract

    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.

    Item Type: Article
    Additional Information: ** From BMJ via Jisc Publications Router **Journal IDs: eissn 1759-1104 **Article IDs: publisher-id: heartasia-2018-011155 **History: published_online 14-08-2019; published 08-2019; accepted 19-07-2019; rev-recd 12-07-2019; submitted 25-11-2018
    Uncontrolled Keywords: Original research, general anesthesia, sedation, arrhythmia, atrial fibrillation
    Identification Number: https://doi.org/10.1136/heartasia-2018-011155
    Page Range: e011155
    SWORD Depositor: Helen Garner
    Depositing User: Helen Garner
    Date Deposited: 22 Aug 2019 16:18
    Last Modified: 22 Aug 2019 16:18
    URI: http://shura.shu.ac.uk/id/eprint/25039

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