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Anaesthesia use in catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies
  1. Ka Hou Christien Li1,
  2. Tian Sang2,
  3. Cheng Chan2,
  4. Mengqi Gong3,
  5. Yingzhi Liu2,
  6. Aaron Jesuthasan1,
  7. Guangping Li3,
  8. Tong Liu3,
  9. Michael H S Lam4,
  10. William KK Wu5,
  11. Matthew T V Chan2,
  12. Fang-zhou Liu3,
  13. Cheng Chen6,
  14. Jeffery Ho2,
  15. Yunlong Xia7,
  16. Gary Tse5
  17. On behalf of International Health Informatics Study (IHIS) Network
  1. 1Cardiovascular research center, Newcastle University, Newcastle, UK
  2. 2Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
  3. 3Atrial fibriallation cente, Tianjin Institute of Cardiology, Tianijin, China
  4. 4Department of Cardiology, Sheffield Hallam University, Sheffield, UK
  5. 5Chinese University of Hong Kong, Shatin, Hong Kong
  6. 6Department of Cardiology, Dalian University, Dalian, China
  7. 7First Affiliated Hospital of Dalian Medical University, Dalian, China
  1. Correspondence to Dr Jeffery Ho,Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong; jeffho{at}cuhk.edu.hk

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.

  • general anesthesia
  • sedation
  • arrhythmia
  • atrial fibrillation
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Footnotes

  • Contributors All authors contributed intellectually to this manuscript.

  • Funding This project was funded by internal research grants from the Chinese University of Hong Kong, Hong Kong, China, and the First Affiliated Hospital of Dalian Medical University, Dalian, China.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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