Conscious or deep sedation reduces procedural time in pulsed field ablation for atrial fibrillationComparing Sedation and General Anesthesia for Pulsed Field Ablation of Atrial Fibrillation

Frontiers in Medicine Published October 24, 2026 DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider conscious or deep sedation to reduce procedural time in pulsed field ablation for atrial fibrillation.

This meta-analysis evaluated the impact of conscious or deep sedation (CS/DS) compared to general anesthesia (GA) in 3,692 patients undergoing pulsed field ablation (PFA) for atrial fibrillation. The analysis synthesized data from 10 studies to compare procedural efficiency and safety outcomes.

The primary finding was a significant reduction in overall procedural time with CS/DS compared to GA (WMD: -7.73 min; 95% CI: -14.17 to -1.29; P = 0.019). Other metrics, including left atrial dwell time (WMD: -2.59 min), fluoroscopy time (WMD: -2.52 min), and acute PVI success (RR: 1.00), showed no significant differences between the two sedation methods. Regarding safety, there was no significant difference in major adverse events (RR: 1.57; 95% CI: 0.81 to 3.05), though a borderline trend toward fewer minor adverse events was noted (RR: 0.61; 95% CI: 0.37 to 1.01; P = 0.053).

The authors note that while CS/DS appears to offer a more efficient procedural timeline without compromising PVI success or safety, the evidence is not definitive. Large-scale randomized controlled trials are required to confirm these findings. Clinicians may consider CS/DS as a viable alternative to GA for PFA procedures to potentially reduce procedural duration.

How this fits prior evidence

This meta-analysis addresses a gap in procedural management for atrial fibrillation by comparing sedation types during pulsed field ablation. While prior evidence indicates that vascular closure devices reduce time to hemostasis by 5.63 minutes in atrial fibrillation ablation, this study specifically addresses the impact of sedation on overall procedural time. The finding that CS/DS reduces procedural time while maintaining comparable safety and PVI success provides a different pathway for optimizing procedural efficiency compared to the mechanical interventions previously discussed.

Doctors are looking for ways to make heart procedures faster and safer. This study looked at over 3,000 patients who underwent a specific type of heart treatment called pulsed field ablation to treat an irregular heartbeat. The researchers compared two ways of keeping patients comfortable during the procedure: light sedation and full general anesthesia.

The results showed that patients who received light sedation had much shorter procedure times. On average, the treatment was finished about 8 minutes faster than those under full general anesthesia. Even though the total time was shorter, the amount of time spent focusing on the left atrium and the time spent using X-ray imaging were about the same for both groups.

Safety was also a key focus of the study. The researchers found no major differences in serious problems between the two groups. There was also a slight trend toward fewer minor issues for patients who received light sedation. These findings suggest that light sedation is a practical choice for doctors to improve efficiency while keeping patients safe.

What this means for you:

Light sedation can shorten procedure times for heart treatments while maintaining similar safety and success rates.

Common questions

Does sedation make the procedure faster?

Yes, the data shows that conscious or deep sedation significantly shortened the overall procedure time by about 8 minutes compared to general anesthesia. However, other factors like the time spent in the left atrium and X-ray exposure did not show a significant difference between the two methods.

Is it safe to use sedation instead of general anesthesia?

The study found no significant difference in major adverse events between the two methods. There was also a borderline trend toward fewer minor adverse events for those who received conscious or deep sedation, though more large-scale trials are needed to confirm these safety findings.

Does the type of sedation affect the success of the treatment?

The success rate for pulmonary vein isolation, which is a key part of the procedure, showed no significant difference between those who received general anesthesia and those who received conscious or deep sedation.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedOct 2026

View Original Abstract ↓

BackgroundPulsed field ablation (PFA) has emerged as a promising therapy for atrial fibrillation. While general anesthesia (GA) is the standard to ensure catheter stability, using conscious or deep sedation (CS/DS) to streamline workflows is gaining interest. However, whether CS/DS provides comparable safety and efficacy to GA remains controversial and has lacked systematic evaluation.ObjectivesTo compare the clinical efficacy and safety of PFA for atrial fibrillation under GA vs. CS/DS.MethodsA literature search was conducted in PubMed, Cochrane Library, and Embase from inception to April 9, 2026. Studies were selected using predefined inclusion and exclusion criteria. The comparison of GA and CS/DS during PFA focused on the following clinical outcomes: procedural time, left atrial dwell time, fluoroscopy time, pulmonary vein isolation (PVI) success rate, and adverse event incidence. Heterogeneity was assessed with the I² statistic and Cochran's Q test; sensitivity analysis was performed if heterogeneity was high. Publication bias was evaluated using funnel plots and Egger's test.ResultsTen studies involving 3,692 atrial fibrillation patients were included. Compared to GA, CS/DS significantly shortened overall procedural time (WMD: −7.73 min, random-effects; 95% CI: −14.17 to −1.29; P = 0.019). However, there were no significant differences between the groups in left atrial dwell time (WMD: −2.59 min, random-effects; 95% CI: −9.74 to 4.57), fluoroscopy time (WMD: −2.52 min, random-effects; 95% CI: −5.31 to 0.28), acute PVI success (RR: 1.00, fixed-effects; 95% CI: 0.98 to 1.03), or major adverse events (RR: 1.57, fixed-effects; 95% CI: 0.81 to 3.05). CS/DS showed a borderline trend toward fewer minor adverse events (RR: 0.61, fixed-effects; 95% CI: 0.37 to 1.01; P = 0.053).ConclusionIn PFA for AF, CS/DS was associated with reduced overall procedural time compared with GA, while maintaining comparable acute PVI success rates and safety profiles. However, large-scale randomized controlled trials are still needed to confirm these findings.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251165071, identifier (CRD420251165071).

Conscious or deep sedation reduces procedural time in pulsed field ablation for atrial fibrillationComparing Sedation and General Anesthesia for Pulsed Field Ablation of Atrial Fibrillation

How this fits prior evidence

Common questions

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Conscious or deep sedation reduces procedural time in pulsed field ablation for atrial fibrillationComparing Sedation and General Anesthesia for Pulsed Field Ablation of Atrial Fibrillation

How this fits prior evidence

Common questions

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