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.