Efficacy and safety of conscious/deep sedation versus general anesthesia in pulsed field ablation for atrial fibrillation: a systematic review and meta-analysis
- 1The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
- 2Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
Abstract
BackgroundPulsed field ablation (PFA) has emerged as a promising therapy for atrial fibrillation. While general anesthesia (GA) is the standard to ensure catheter stability, using conscious or deep sedation (CS/DS) to streamline workflows is gaining interest. However, whether CS/DS provides comparable safety and efficacy to GA remains controversial and has lacked systematic evaluation.ObjectivesTo compare the clinical efficacy and safety of PFA for atrial fibrillation under GA vs. CS/DS.MethodsA literature search was conducted in PubMed, Cochrane Library, and Embase from inception to April 9, 2026. Studies were selected using predefined inclusion and exclusion criteria. The comparison of GA and CS/DS during PFA focused on the following clinical outcomes: procedural time, left atrial dwell time, fluoroscopy time, pulmonary vein isolation (PVI) success rate, and adverse event incidence. Heterogeneity was assessed with the I² statistic and Cochran's Q test; sensitivity analysis was performed if heterogeneity was high. Publication bias was evaluated using funnel plots and Egger's test.ResultsTen studies involving 3,692 atrial fibrillation patients were included. Compared to GA, CS/DS significantly shortened overall procedural time (WMD: −7.73 min, random-effects; 95% CI: −14.17 to −1.29; P = 0.019). However, there were no significant differences between the groups in left atrial dwell time (WMD: −2.59 min, random-effects; 95% CI: −9.74 to 4.57), fluoroscopy time (WMD: −2.52 min, random-effects; 95% CI: −5.31 to 0.28), acute PVI success (RR: 1.00, fixed-effects; 95% CI: 0.98 to 1.03), or major adverse events (RR: 1.57, fixed-effects; 95% CI: 0.81 to 3.05). CS/DS showed a borderline trend toward fewer minor adverse events (RR: 0.61, fixed-effects; 95% CI: 0.37 to 1.01; P = 0.053).ConclusionIn PFA for AF, CS/DS was associated with reduced overall procedural time compared with GA, while maintaining comparable acute PVI success rates and safety profiles. However, large-scale randomized controlled trials are still needed to confirm these findings.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251165071, identifier (CRD420251165071).
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BibTeX
@article{sun2026efficacy,
title = {{Efficacy and safety of conscious/deep sedation versus general anesthesia in pulsed field ablation for atrial fibrillation: a systematic review and meta-analysis}},
author = {Weiwei Sun and Ruiting Feng and Xiaohong Fu and Nan Zhang and Meng Sun and Min Guo and Jia Gao and Rui Wang},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1933701},
url = {https://doi.org/10.3389/fcvm.2026.1933701},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Efficacy and safety of conscious/deep sedation versus general anesthesia in pulsed field ablation for atrial fibrillation: a systematic review and meta-analysis
AU - Weiwei Sun
AU - Ruiting Feng
AU - Xiaohong Fu
AU - Nan Zhang
AU - Meng Sun
AU - Min Guo
AU - Jia Gao
AU - Rui Wang
PY - 2026
DA - 2026/10/23
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1933701
UR - https://doi.org/10.3389/fcvm.2026.1933701
AB - BackgroundPulsed field ablation (PFA) has emerged as a promising therapy for atrial fibrillation. While general anesthesia (GA) is the standard to ensure catheter stability, using conscious or deep sedation (CS/DS) to streamline workflows is gaining interest. However, whether CS/DS provides comparable safety and efficacy to GA remains controversial and has lacked systematic evaluation.ObjectivesTo compare the clinical efficacy and safety of PFA for atrial fibrillation under GA vs. CS/DS.MethodsA literature search was conducted in PubMed, Cochrane Library, and Embase from inception to April 9, 2026. Studies were selected using predefined inclusion and exclusion criteria. The comparison of GA and CS/DS during PFA focused on the following clinical outcomes: procedural time, left atrial dwell time, fluoroscopy time, pulmonary vein isolation (PVI) success rate, and adverse event incidence. Heterogeneity was assessed with the I² statistic and Cochran's Q test; sensitivity analysis was performed if heterogeneity was high. Publication bias was evaluated using funnel plots and Egger's test.ResultsTen studies involving 3,692 atrial fibrillation patients were included. Compared to GA, CS/DS significantly shortened overall procedural time (WMD: −7.73 min, random-effects; 95% CI: −14.17 to −1.29; P = 0.019). However, there were no significant differences between the groups in left atrial dwell time (WMD: −2.59 min, random-effects; 95% CI: −9.74 to 4.57), fluoroscopy time (WMD: −2.52 min, random-effects; 95% CI: −5.31 to 0.28), acute PVI success (RR: 1.00, fixed-effects; 95% CI: 0.98 to 1.03), or major adverse events (RR: 1.57, fixed-effects; 95% CI: 0.81 to 3.05). CS/DS showed a borderline trend toward fewer minor adverse events (RR: 0.61, fixed-effects; 95% CI: 0.37 to 1.01; P = 0.053).ConclusionIn PFA for AF, CS/DS was associated with reduced overall procedural time compared with GA, while maintaining comparable acute PVI success rates and safety profiles. However, large-scale randomized controlled trials are still needed to confirm these findings.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251165071, identifier (CRD420251165071).
SN - 2297-055X
ER -