Worldwide sedation strategies for atrial fibrillation ablation: current status and evolution over the last decade.

Catheter ablation for atrial fibrillation (AF) has become one of the most common procedures in the electrophysiology lab with rapidly increasing volumes. Peri-procedural anaesthesia for AF ablation varies between centres, from general anaesthesia to deep or conscious sedation. The aim of this survey was to assess current sedation practices for AF ablation worldwide and its evolution over the last decade. Centres regularly performing AF ablation responded to an online survey. A total of 297 centres participated in the survey. Overall, the median (interquartile range) number of AF ablation procedures increased from 91 (43-200) to 200 (74-350) per year (P < 0.001) between 2010 and 2019. The proportion of cryoablation also increased from 17.0% to 33.2% (P < 0.001). In 2019, the most used sedation technique was general anaesthesia (40.5%), followed by conscious sedation (32.0%) and deep sedation (27.5%). Between 2010 and 2019, the proportion of procedures performed under general anaesthesia (+4.4%; P = 0.02) and deep sedation (+4.8%; P < 0.01) increased, whereas the use of conscious sedation decreased (-9.2%; P < 0.001). The most commonly used hypnotic drugs were propofol and midazolam, whereas the most commonly used opioid drugs were remifentanyl and fentanyl. This worldwide survey shows that the number of AF ablation procedures has more than doubled over the last decade and general anaesthesia remains most commonly used. Studies comparing outcomes between different sedation strategies are needed to guide optimal decision-making.

Cost-Effectiveness and Cost-Utility Analyses of Dabigatran Compared with Warfarin in Patients with Nonvalvular Atrial Fibrillation and Risk Factors for Stroke and Systemic Embolism within Brazilian Private and Public Health Care Systems Perspectives.

OBJECTIVE: To analyze the cost-effectiveness and cost-utility of dabigatran compared with warfarin in patients with nonvalvular atrial fibrillation with moderate to high risk of ischemic stroke or systemic embolism and eligible for treatment with anticoagulants. METHODS: Markov-based economic analysis was performed to estimate treatment costs and outcomes. Epidemiological and efficacy data were determined after a critical revision of the medical literature. Unit costs were taken from Brazilian official databases. Only direct medical costs were covered. Costs and benefits were discounted at a rate of 5% per year. Outcomes were expressed as life-year (LY) and quality-adjusted life-year (QALY). RESULTS: Dabigatran use is cost-effective in terms of LY and QALY considering a willingness-to-pay threshold of 3 times gross domestic product per capita of 2010 (Brazilian real 57,048/US $24,275.74) per LY and QALY saved in both analyzed perspectives (private and public health care systems). CONCLUSIONS: Dabigatran use improves patient survival and quality of life compared with warfarin. This represents the best therapeutic option in terms of cost and effectiveness in the prevention of ischemic stroke and systemic embolism in patients with nonvalvular atrial fibrillation.