Conscious Sedation Versus General Anesthesia for Percutaneous Left Atrial Appendage Occlusion: A Systematic Review and Meta-Analysis.

BACKGROUND

Percutaneous left atrial appendage occlusion (LAAO) has traditionally been performed under general anesthesia (GA) to maintain patient comfort and immobility, especially in the setting of transesophageal echocardiography.

AIMS: We aimed to compare the safety and efficacy of conscious sedation (CS) compared to GA for LAAO, concurrent with the expansion of intracardiac echocardiography guidance.

METHODS

A systematic search of the PubMed, Embase, Cochrane Central, and Scopus databases was conducted through December 2024 for studies comparing CS versus GA for LAAO. For outcomes of procedural complications and characteristics, random-effects models were used to calculate the mean difference (MD), odds ratio (OR), and risk ratio (RR) effect estimates with 95% confidence intervals (CIs).

RESULTS

Four studies with 1540 patients undergoing LAAO were included (CS = 678, GA = 862). CS was associated with significantly shorter total procedural time [MD -11.95 min; 95% CI -19.52 to -2.78; p = 0.009] and a lower volume of contrast media [MD -31.90 mL; 95% CI -56.72 to -7.08; p = 0.01]. No significant differences were noted for total fluoroscopy time, total length of hospital stay, device success, all-cause mortality, cardiovascular mortality, stroke, device-related thrombus, and peri-device leak > 5 mm.

CONCLUSION

Percutaneous LAAO using CS allows for faster procedures and lower contrast media volumes compared to GA without compromising device success and clinical outcomes. Randomized studies with longer follow-ups are necessary to understand the long-term outcomes of percutaneous LAAO using CS.