Abstract
Aims Outcome of persistent atrial fibrillation (AF) ablation remains suboptimal. Techniques employed to reduce arrhythmia recurrence rate are more likely to be embraced if cost-effectiveness can be demonstrated. A single-centre observational study assessed whether use of general anaesthesia (GA) in persistent AF ablation improved outcome and was cost-effective.
Methods 292 patients undergoing first ablation procedures for persistent AF under conscious sedation or GA were followed. End points were freedom from listing for repeat ablation at 18 months and freedom from recurrence of atrial arrhythmia at one year.
Results Freedom from atrial arrhythmia was higher in patients who underwent ablation under GA rather than sedation (63.9% vs 42.3%, HR 1.87, 95% CI: 1.23 to 2.86, p = 0.002). Significantly fewer GA patients were listed for repeat procedures (29.2% vs 42.7%, HR 1.62, 95% CI: 1.01 to 2.60, p = 0.044). Despite GA procedures costing slightly more, a saving of £177 can be made per patient in our centre for a maximum of 2 procedures if all persistent AF ablations are performed under GA.
Conclusions In patients with persistent AF, it is both clinical and economically more effective to perform ablation under GA rather than sedation.
What’s New?
There is very little known regarding the clinical outcome of catheter ablation of AF under GA compared with sedation; to our knowledge there is one study only in paroxysmal AF and no studies examining cost effectiveness.
This study shows that in patients with persistent AF, it is both clinical and economically more effective to perform ablation under GA rather than sedation.
This study leads us to recommend the use of GA for the ablation of persistent AF. As PAF ablation is now increasingly being undertaken by single shot techniques which do not have the same requirements for analgesia and immobility, GA resources may be allocated for persistent AF ablation.
