A comparison of patient experience with conscious sedation versus general anaesthesia for radiofrequency pulmonary vein isolation

Abstract Background Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). Patients are administered Conscious Sedation (CS) or General Anaesthesia (GA) to minimise discomfort and patient movement during PVI. When considering which mode of anaesthesia to use for PVI, the likelihood of technical procedural success must be balanced with the patient’s wishes, as well as their suitability for different types of anaesthesia. Purpose To the best of our knowledge, there is little research to date on patient-reported experiences of different modes of anaesthesia used for radiofrequency PVI. As such, we conducted this study to address this gap in the literature and to, more importantly, improve patient care and clinical outcomes. Methods This is a retrospective observational single-centre single-operator study comparing patient experiences with RF PVI performed under GA versus CS, as measured by a questionnaire derived from Likert scale and Euro-Qol 5D validated tools 1,2. The domains analysed included pain/discomfort during the procedure, anxiety/depression post-procedure, satisfaction with recovery time post-procedure, Likelihood To Recommend (LTR) the procedure, LTR mode of anaesthesia, overall satisfaction with the ablation experience. The mode of anaesthesia for each patient was determined by perceived airway risk and anaesthetist availability on the day of the procedure. The conscious sedation protocol consisted of a bolus of midazolam and fentanyl at the onset of case and as required thereafter based on patient comfort, movement and non-invasive vital signs. The general anesthesia protocol consisted of propofol induction, muscle paralysis with rocuronium, endotracheal intubation with ventilation, maintenance of anaesthesia with sevoflurane and remifentanyl infusion. All cases were admitted to hospital overnight post-procedure for observation with no differences in procedural approach otherwise between two groups. Results 41 patients were included - 20 in CS arm, and 21 in GA arm. Groups were well-matched in terms of age (mean overall 57.7 years), gender (70.7% male overall), percentage of re-do procedures (24.3% overall) and percentage of paroxysmal AF (68.1% overall). There was a significantly higher amount of pain/discomfort in conscious sedation group compared to GA group (p<0.001)(picture 1). Patients were significantly more likely to recommend GA than CS(p<0.001). There were no other differences noted in patient-reported outcomes. Mean procedural time was significantly less in GA arm (75.5 +/- 17.3 minutes) than CS arm (119.7 +/- 34.9 minutes) (p<.001) (picture 2). There were no adverse events in either arm. Conclusion In this single-centre single-operator observational study, we found that general anaesthesia was associated with reduced pain/discomfort during radiofrequency pulmonary vein isolation when compared to conscious sedation.Bar chart of pain/discomfort Boxplot of total procedure duration