Department of Cardiology, Herlev-Gentofte University Hospital, University of Copenhagen, Gentofte Hospitalsvej 6, 2900 Hellerup, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Europace. 2024 Aug 3;26(8). doi: 10.1093/europace/euae203.
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) vs. general anaesthesia (GA) during CA.
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 drug (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. The study cohort comprised 7957 (6421 CS and 1536 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 1 (46% vs. 37%) and at 5 (68% vs. 63%) years. Multivariate analysis revealed CS as significantly associated with increased risk of AF recurrence at 5-year follow-up [hazard ratio 1.26 (95% confidence interval 1.15-1.38)], consistent across paroxysmal and persistent AF subtypes.
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.
导管消融（CA）是治疗心房颤动（AF）的一种成熟的治疗方法，其中镇静和镇痛对于患者的舒适度和病变形成至关重要。麻醉类型对 AF 复发率的影响仍不确定。本研究旨在检查 CA 过程中使用镇静（CS）与全身麻醉（GA）时 AF 复发率。
我们利用丹麦医疗保健登记处的全国性数据，进行了这项队列研究，纳入了 2010 年至 2018 年间首次接受 CA 治疗 AF 的成年人（≥18 岁）。根据麻醉类型（CS 或 GA）对患者进行分类，主要终点是 AF 复发，定义为抗心律失常药物（AAD）处方、AF 相关住院、电复律或 AF 再消融的复合终点。使用多变量 Cox 比例风险分析评估麻醉类型的影响。研究队列包括 7957 名患者（6421 名 CS 和 1536 名 GA）。GA 组中持续性 AF、高血压和心力衰竭以及 AAD 的使用更为常见。CS 组的复发 AF 累积发生率在 1 年（46%比 37%）和 5 年（68%比 63%）时更高。多变量分析显示，CS 与 5 年随访时 AF 复发风险增加显著相关[风险比 1.26（95%置信区间 1.15-1.38）]，在阵发性和持续性 AF 亚组中均一致。
这项全国性队列研究表明，与 GA 相比，CA 期间 CS 与 AF 复发风险增加相关。这些结果主张考虑 GA 作为改善 CA 结果的首选麻醉类型。
