Patel Shubh, Deng Jiawen, Zubair Areeba, Heybati Kiyan, Heybati Shayan, Chang Oswin, Abbas Umaima, Tahir Umair, Ramaraju Harikrishnaa B, Wong Chi Y, Dhivagaran Thanansayan, Rayner Daniel, Krever Magnus, Woelber Tiffany, Kowlgi Gurukripa N, Ramakrishna Harish
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Alix School of Medicine, USA.
Ann Card Anaesth. 2025 Apr 1;28(2):119-127. doi: 10.4103/aca.aca_229_24. Epub 2025 Apr 16.
Ventricular arrhythmias (VA), including ventricular tachycardia and fibrillation, are critical cardiac conditions that are often managed by catheter ablation among those unresponsive to pharmacologic therapy. The choice of anesthesia and sedation regimens for VA ablations may impact arrhythmia inducibility and hemodynamic stability, which can affect procedural success and complication rates. This systematic review and meta-analysis aimed to compare the efficacy and safety of sedation versus general anesthesia (GA) among patients undergoing VA ablation. The review was prospectively registered on PROSPERO (CRD42023441553). Database searches were conducted across five major databases from inception to March 9, 2024 to identify randomized trials or observational studies including adult patients undergoing ablations for VA. Screening and data extraction were completed in duplicate. Risk-of-bias assessments were conducted using ROBINS-I as all included studies were observational, and the quality of evidence was evaluated using the GRADE framework. Six observational studies (N = 16,435) were included. No significant differences were found between sedation and GA for total procedure time (MD: -14.16 minutes; 95%CI: -38.61 to 10.29 minutes), arrhythmia non-inducibility (RR: 0.73; 95% CI: 0.33-1.58), acute ablation success (RR: 1.06; 95% CI: 0.65-1.71), or procedural complications (RR: 0.72; 95% CI: 0.28-1.85). However, sedation was associated with significantly lower intraprocedural hemodynamic instability (RR: 0.28; 95% CI: 0.12-0.70). These findings indicate that while sedation and GA have comparable outcomes, sedation may be associated with less hemodynamic instability during VA ablation. However, more high-quality studies are needed to confirm these results.
室性心律失常（VA），包括室性心动过速和颤动，是严重的心脏疾病，对于那些对药物治疗无反应的患者，通常通过导管消融来处理。VA消融的麻醉和镇静方案选择可能会影响心律失常的可诱导性和血流动力学稳定性，进而影响手术成功率和并发症发生率。本系统评价和荟萃分析旨在比较VA消融患者中镇静与全身麻醉（GA）的疗效和安全性。该评价已在PROSPERO（CRD42023441553）上进行前瞻性注册。从各数据库建立至2024年3月9日，在五个主要数据库中进行检索，以识别包括接受VA消融的成年患者的随机试验或观察性研究。筛查和数据提取由两人独立完成。由于所有纳入研究均为观察性研究，因此使用ROBINS - I进行偏倚风险评估，并使用GRADE框架评估证据质量。纳入了六项观察性研究（N = 16,435）。在总手术时间（MD：-14.16分钟；95%CI：-38.61至10.29分钟）、心律失常不可诱导性（RR：0.73；95%CI：0.33 - 1.58）、急性消融成功率（RR：1.06；95%CI：0.65 - 1.71）或手术并发症（RR：0.72；95%CI：0.28 - 1.85）方面，镇静和GA之间未发现显著差异。然而，镇静与术中血流动力学不稳定显著降低相关（RR：0.28；95%CI：0.12 - 0.70）。这些发现表明，虽然镇静和GA的结果相当，但在VA消融过程中，镇静可能与较少的血流动力学不稳定相关。然而，需要更多高质量的研究来证实这些结果。
