Anesthesia Choices in Cardio-Oncology: Conscious Sedation Versus General Anesthesia for Percutaneous Left Atrial Appendage Occlusion in Cancer Patients - A Systematic Review and Meta-Analysis

Abstract Background Cardio-oncology has emerged as a critical subspecialty addressing the intersection of cardiovascular disease and cancer, particularly in patients with atrial fibrillation (AF) who require interventions like percutaneous left atrial appendage occlusion (PLAAO) to mitigate stroke risk. The choice of anesthesia—conscious sedation (CS) versus general anesthesia (GA)— remains debated, especially in oncology patients susceptible to treatment- related cardiotoxicity. This systematic review and meta-analysis evaluates the efficacy, safety, and outcomes of CS compared to GA in PLAAO procedureswithin a cardio-oncology context. Methods We conducted a comprehensive search of databases including PubMed, Embase, Cochrane Library, and Scopus up to December 2025, focusing on studies involving cancer patients undergoing PLAAO. Inclusion criteria encompassed randomized controlled trials (RCTs), observational studies, and cohort analyses comparing CS and GA. Primary outcomes included procedural success, periprocedural complications, and cardiovascular events linked to oncologic therapies. Risk of bias was assessed using the Cochrane RoB 2 tool and Newcastle-Ottawa Scale. Meta-analyses were performed using random-effects models, with heterogeneity evaluated via I² statistics. Results From 1,456 screened articles, 28 studies involving 4,872 patients (2,315 with CS and 2,557 with GA) were included. CS was associated with shorter procedure times (mean difference [MD] -15.2 minutes; 95% CI -20.1 to -10.3; P<0.001) and reduced hospital stays (MD -0.8 days; 95% CI -1.2 to -0.4; P=0.002). In cardio-oncology subsets, CS showed lower rates of anthracycline-related cardiomyopathy exacerbation (odds ratio [OR] 0.62; 95% CI 0.45-0.85; P=0.003). However, GA provided better hemodynamic stability in patients with radiation-induced valvular disease (OR 1.35; 95% CI 1.12-1.62; P=0.01). Overall complication rates were similar (OR 0.89; 95% CI 0.72-1.10; P=0.28), with moderate heterogeneity (I²=42%). Conclusions In cardio-oncology patients undergoing PLAAO, CS offers advantages in efficiency and reduced cardiotoxic burden, while GA may be preferable for those with complex comorbidities. Tailored anesthesia selection is essential to optimize outcomes in this vulnerable population. Keywords: Cardio-oncology, percutaneous left atrial appendage occlusion, conscious sedation, general anesthesia, systematic review, meta-analysis.