Abstract
<title>Abstract</title> <p>Background Patients undergoing pulsed field ablation (PFA) for atrial fibrillation (AF) often have comorbid cardiovascular diseases and are highly sensitive to circulatory depression during anesthesia induction. This study aimed to compare the hemodynamic stability and postoperative recovery outcomes between oliceridine, a novel G protein-biased µ-opioid receptor agonist, and the traditional opioid sufentanil for general anesthesia in AF PFA surgery. Methods We retrospectively enrolled 190 patients undergoing elective AF PFA surgery under general anesthesia at our center between January 2025 and March 2026. Patients were divided into the oliceridine group (104 patients, received 0.03 mg/kg oliceridine) and the sufentanil group (86 patients, received 0.2 µg/kg sufentanil) based on the induction agent used. 1:1 nearest neighbor propensity score matching (PSM) was used to balance baseline confounding factors, including 11 covariates such as age, gender, BMI, ASA classification, and comorbidities, with a caliper value of 0.1. After matching, 71 patients were included in each group for analysis. The primary endpoint was mean arterial pressure (MAP) at 5 minutes after induction. Secondary endpoints included perioperative hemodynamics, postoperative recovery indicators, analgesic efficacy, and the incidence of adverse events. Bonferroni correction was applied for multiple comparisons, with P < 0.017 considered statistically significant. Results After matching, baseline characteristics were well balanced between the two groups, with all covariates showing P > 0.05 and standardized mean differences (SMD) < 0.12. The oliceridine group had significantly higher MAP and heart rate at 1, 3, and 5 minutes after induction compared with the sufentanil group (all P < 0.017), with smaller hemodynamic fluctuations during induction. Compared with the sufentanil group, the oliceridine group had a 6.3% shorter time to spontaneous eye opening (4.5 ± 0.8 min vs 4.8 ± 0.9 min, P = 0.034) and an 8.9% shorter time to discharge from the catheterization laboratory (22.6 ± 4.1 min vs 24.8 ± 4.5 min, P = 0.003). The incidence of major perioperative adverse events was significantly lower in the oliceridine group (40.8% vs 66.2%, P = 0.018), with significantly reduced usage of vasoactive agents such as phenylephrine and atropine (all P < 0.05). Postoperative analgesic efficacy was comparable between the two groups at all time points. The oliceridine group also showed significantly smaller increases in postoperative ALT and AST levels (all P < 0.05), with no significant differences in Scr and BUN changes. Conclusions For general anesthesia in AF PFA surgery, oliceridine provides equivalent postoperative analgesic efficacy to sufentanil, while maintaining more stable perioperative hemodynamics, accelerating postoperative recovery, reducing anesthesia-related adverse events, and exerting a smaller impact on liver function. It represents a safer induction agent option for patients undergoing AF PFA surgery.</p>