General anesthesia enhances lesion quality and ablation efficiency of circumferential pulmonary vein isolation.

BACKGROUND: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. General anesthesia (GA) resolves the problem of pain intolerability and provides regular respiratory mode which might improve the catheter maneuverability of AF ablation. This study aims to compare the procedural performance of PVI under GA versus conscious sedation (CS) from multiple perspectives.

METHODS: A total of 36 consecutive patients undergoing first AF ablation under GA were enrolled in GA group. Another 109 patients receiving AF ablation under CS in the same period were selected as the control group. After propensity score matching, 29 matched pairs with similar baseline characteristics were available for further analysis. The AIFV (using AI to analyze the raw data from CARTO3 system) system was used to evaluate six procedural parameters in each PVI procedure.

RESULTS: Compared with CS, PVI under GA had a significantly shorter total PVI time (51.4 min vs. 67.8 min; p  = .003) and higher radiofrequency ratio (62.6% vs. 55.8%; p  = .032). The number of gaps (1.0 vs. 3.0; p  < .001) and the rate of break point were significantly lower in the GA group. GA was also associated with a higher effective ablation-index ratio (87.5% vs. 74.1%; p  < .001) and effective force-over-time ratio (85.3% vs. 69.2%; p  = .001). After a medium follow-up time of 24 months, 12/29 (41.4%) patients in the CS group and 6/29 (20.7%) patients in the GA group suffered from AF recurrence ( p  = .156).

CONCLUSIONS: GA improves the lesion quality and procedural efficiency of PVI from multiple perspectives evaluated by the AIFV system.