Anesthesia and sedation management of radiofrequency catheter ablation for atrial fibrillation: a systematic review

Abstract

Objective As an effective treatment for atrial fibrillation, radiofrequency catheter ablation can be performed under different anesthetic managements, including conscious sedation, deep sedation and general anesthesia.However, the effects of these three anesthetic managements on the radiofrequency therapy have not been systematically reviewed.This systematic review aimed at evaluating the effect of different anesthetic managements on ablation procedure, success rate and complication occurrence. Methods We systematically searched MEDLINE, Cochrane Library, and EMBASE databases for clinical trials published between January 2000 and December 2013, and 4 randomized controlled trials had been included. Results The significant high level of heterogeneity of the studies prohibited a meta-analysis.The main findings were: ① Controversial effects of different anesthetic managements on the procedural time and fluoroscopy time due to the induced bias.② No statistical significance was recognized on the success rate of pulmonary vein isolation under different anesthetic strategies.③ The recurrence of atrial fibrillation and pulmonary vein reconnection rate in the general anesthesia group was significantly lower than that of the conscious sedation ( P<0.001). ④ Patients under conscious sedation experienced less possibility of hypotension ( P<0.001), hypoxia ( P<0.001) and were less likely to suffer from esophageal injuries (P<0.001). ⑤ Compared with deep sedation, the satisfactory rate of electrophysiologists was higher in conscious sedation group (P=0.002). Conclusion Both conscious sedation and general anesthesia could be applied as anesthetic managements for the radiofrequency catheter ablation therapy of atrial fibrillation. Key words: Atrial fibrillation; Radiofrequence catheter ablation; Conscious sedation; Deep sedation; General anesthesia