Anesthetic Approaches for Left Atrial Appendage Occlusion: Comparing Conscious Sedation and General Anesthesia: A Meta Analysis

Abstract

Background Left atrial appendage occlusion (LAAO) offers a mechanical alternative to anticoagulation for stroke prevention in nonvalvular atrial fibrillation patients. However, the optimal anesthetic strategy—general anesthesia (GA) versus conscious sedation (CS)—during LAAO remains unclear. Methods A systematic search of PubMed, Google Scholar, Cochrane, and ScienceDirect was conducted up to September 2024. Studies comparing CS and GA during LAAO were included. Statistical analyses were performed using RevMan 5.4, reporting pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Results Three studies involving 1,395 patients were included. Conscious sedation 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 observed in pericardial tamponade ( p  = 0.31), 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 also statistically similar between groups. Conclusion This meta-analysis suggests that conscious sedation during LAAO is associated with reduced device-related thrombus and shorter procedure duration without increasing complication or mortality risk. These findings support the use of conscious sedation as a safe and efficient anesthetic alternative in appropriately selected patients undergoing LAAO.