Abstract 4367210: A Systematic Review and Meta-Analysis on the Anesthetic Approaches for Left Atrial Appendage Occlusion: Comparing Conscious Sedation and General Anesthesia

Abstract

Background: Left atrial appendage occlusion (LAAO) provides a mechanical alternative to anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation. The optimal anesthetic strategy—general anesthesia (GA) versus conscious sedation (CS)—remains uncertain. Objective: We conducted a meta-analysis to compare the procedural and safety outcomes of CS versus GA in patients undergoing LAAO. Methods: A systematic search of PubMed, Google Scholar, Cochrane, and ScienceDirect was performed through January 2024 to identify studies comparing CS and GA during LAAO. Inclusion criteria were comparative studies reporting procedural and safety outcomes. Data extraction and quality assessment were conducted independently by two reviewers. Statistical analyses were performed using RevMan 5.4. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results: Three studies comprising 1,395 patients met the inclusion criteria. CS was associated with a significantly lower incidence of device-related thrombus (OR: 0.17 [0.03, 0.98], p = 0.05) and shorter procedure time (MD: –7.17 minutes [–9.34, –5.01], p < 0.0001). No significant differences were found between CS and GA for pericardial tamponade ( p = 0.31), major bleeding ( p = 0.27), shock ( p = 0.70), vascular hematoma ( p = 0.95), stroke ( p = 0.11), cardiovascular mortality ( p = 0.55), or all-cause mortality ( p = 0.85). Procedural outcomes—including technical success ( p = 0.36), procedural success ( p = 0.35), peri-device leak <5 mm ( p = 0.28), and fluoroscopy time ( p = 0.07)—were comparable between the two groups. Conclusion: In patients undergoing LAAO, conscious sedation is associated with reduced device-related thrombus and shorter procedure duration without increasing periprocedural complications or mortality. These findings support the safety and efficiency of conscious sedation as a viable anesthetic approach in selected patients.