Abstract Body (Do not enter title and authors here): Background: Catheter ablation has become an established treatment modality for symptomatic atrial fibrillation (AF), with its utilization steadily increasing. However, the optimal anesthetic approach—conscious sedation (CS) versus general anesthesia (GA)—and its potential impact on procedural characteristics, efficacy, and safety remain points of discussion. This study provides a systematic review and meta-analysis of available evidence comparing CS and GA as anesthetic approaches for patients undergoing AF ablation.
Methods: A comprehensive literature search was conducted across CENTRAL, PubMed, Embase, and Web of Science databases up to March 2025. We included randomized controlled trials (RCTs) and observational studies that compared outcomes between CS and GA in adults undergoing radiofrequency or cryoballoon AF ablation. Data were pooled using a random-effects model, applying odds ratios (ORs) for binary outcomes and mean differences (MDs) for continuous outocmes. Statistical heterogeneity was assessed using the I². All statistical analyses were performed using R software (version 4.4.2).
Results: Twelve studies encompassing 10,579 patients were included in this meta-analysis. There were no significant differences between the CS and GA groups in total procedure time (SMD: 0.16; 95% CI: -0.29 to 0.60; p = 0.45; I² = 94.9%) or fluoroscopy time (SMD: 0.42; 95% CI: -0.29 to 1.13; p = 0.19; I² = 96.5%). The recurrence of atrial arrhythmias was also similar between groups (RR: 1.29; 95% CI: 0.97–1.70; p = 0.07; I² = 63.3%). There were also no significant differences in complication rates (OR: 1.17; 95% CI: 0.81–1.68; p = 0.40; I² = 0%) or re-ablation rates (OR: 1.62; 95% CI: 0.89–2.97; p = 0.09; I² = 65.9%).
Conclusion: Our meta-analysis did not identify significant differences in procedural or clinical outcomes between CS and GA in adults undergoing AF ablation. This suggests that both anesthetic approaches may be viable options, with the selection potentially influenced by factors such as institutional protocols and individual patient profiles. Nevertheless, the observed heterogeneity and inherent limitations within the current body of evidence underscore the need for future large-scale, rigorously designed RCTs to establish more definitive conclusions regarding the optimal anesthetic strategy for AF ablation.