Conscious Sedation Versus General Anesthesia for Percutaneous Left Atrial Appendage Occlusion: A Systematic Review...

Area of Science:

• Cardiology
• Interventional Cardiology
• Anesthesiology

Background:

• Percutaneous left atrial appendage occlusion (LAAO) traditionally requires general anesthesia (GA) for patient comfort and immobility.
• Transesophageal echocardiography is often used during LAAO procedures under GA.

Purpose of the Study:

• To compare the safety and efficacy of conscious sedation (CS) versus GA for LAAO.
• To evaluate LAAO outcomes with the increasing use of intracardiac echocardiography guidance.

Main Methods:

• Systematic literature search of major databases (PubMed, Embase, Cochrane Central, Scopus) up to December 2024.
• Random-effects models used to analyze procedural complications and characteristics, calculating mean differences and odds/risk ratios with 95% confidence intervals.
• Four studies involving 1540 patients (678 CS, 862 GA) were included in the meta-analysis.

Main Results:

• CS was associated with significantly shorter procedural times (MD -11.95 min) and lower contrast media volume (MD -31.90 mL).
• No significant differences were observed in fluoroscopy time, hospital stay, device success, or major adverse events including mortality, stroke, thrombus, and peri-device leak.
• CS demonstrated comparable safety and efficacy to GA for LAAO procedures.

Conclusions:

• Percutaneous LAAO under CS is feasible, leading to quicker procedures and reduced contrast use without compromising clinical outcomes.
• Further randomized trials with extended follow-up are needed to fully ascertain the long-term benefits of CS for LAAO.