Association of Anesthesia Modality With Procedural Parameters and Clinical Outcomes in PVI for Atrial Fibrillation

Area of Science:

• Electrophysiology
• Cardiac Ablation
• Anesthesiology

Background:

• Pulmonary vein isolation (PVI) is a key treatment for atrial fibrillation (AF).
• Anesthesia choice (general anesthesia vs. conscious sedation) may impact PVI outcomes.
• Previous research has not fully explored the impact of anesthesia on intraprocedural catheter stability and lesion quality.

Purpose of the Study:

• To compare the effects of general anesthesia (GA) versus conscious sedation (CS) on intraoperative catheter stability, lesion continuity, and clinical outcomes during PVI.
• To investigate the relationship between anesthesia type, catheter swing, interlesion distance (ILD), and acute pulmonary vein reconnection.

Main Methods:

• Retrospective analysis of 147 patients undergoing their first PVI procedure.
• Comparison of catheter swing, contact force (CF), ablation index (AI), ILD, acute pulmonary vein reconnection, and 12-month recurrence between GA and CS groups.

Main Results:

• General anesthesia was associated with significantly reduced catheter swing, shorter ILD, and lower rates of acute pulmonary vein reconnection compared to conscious sedation.
• The GA group demonstrated a higher 12-month success rate (lower recurrence) than the CS group.
• Catheter swing was identified as a mediator linking anesthesia strategy to acute reconnection and overall postoperative success.

Conclusions:

• General anesthesia may lead to more stable catheter positioning and continuous lesions during PVI.
• Reduced acute pulmonary vein reconnection under GA is a key factor contributing to improved long-term freedom from AF.
• These findings suggest GA may facilitate more durable lesion formation, improving PVI efficacy.