Introduction Up to 6% of patients experience complications after radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). The purpose of this study is to determine the prevalence and predictors of periprocedural complications after RFA for AF. Methods and Results The subjects were 1295 consecutive patients (age=60±10 years) who underwent RFA (n=1642) for paroxysmal (53%) or persistent AF (47%) from January 2007 to January 2010. A complication occurred in 57 patients (3.5%); a vascular access complication in 31 (1.9%); pericardial tamponade in 20 (1.2%); a thromboembolic event in 4 (0.2%); deep venous thrombosis in 1 (<0.01%); and pulmonary vein stenosis in 1 patient (<0.01%). There were no procedure-related deaths. On multivariate analysis, female gender (OR=2.27; ±95% CI: 1.31–2.57, P<0.01) and procedures performed in July or August (OR=2.10; ±95% CI: 1.16–3.80, P=0.01) were independent predictors of any complication. For vascular complications, treatment with clopidogrel (OR=4.40; ±95% CI: 1.43–13.53, P=0.01), female gender (OR=3.65; ±95% CI: 1.72–7.75, P<0.01) and performing RFA in July or August (OR=2.71; ±95% CI: 1.25–5.87, P=0.01) were independent predictors. The only predictor of cardiac tamponade was prior RFA (OR=3.32; ±95% CI: 0.95–11.61; P<0.05). Conclusion Prevalence of perioperative complications for RFA of AF is 3.5% and vascular access complications constitute the majority. The need for clopidogrel therapy should be carefully considered prior to RFA. At teaching institutions close supervision should be exercised during vascular access early in the year. Improvements in ablation technology and elimination of the need for repeat procedures may decrease the risk of pericardial tamponade.

Recent evidence suggests that outcomes do not meaningfully differ between thoracic surgery patients who are ventilated with a low or higher tidal volume and the effects of low versus higher positive end-expiratory pressure are unclear.

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We read with great interest the correspondence of Zhang and colleagues, which reported the economic impact of the use of video laryngoscopy (VL) compared with direct laryngoscopy (DL) in the surgical setting for both routine and difficult adult airways [1]. The authors suggest that the video laryngoscope group had lower hospital costs, shorter length of hospital stay, reduced rate of intensive care unit admissions and fewer complications. We commend the authors for their timely contribution to the evolving literature on airway management, and its impact on healthcare economics and quality. We wish further to propose several pathways that may help explain the historical pathway that got us to where we are today.DL originated in the 1940s, both in straight blade [2] and curved blade [3] models, based upon the improvements in design, allowing portability and the widespread use of cyclopropane, which depressed both cardiovascular function and ventilatory drive. Although there were, and are, aficionados of both models and the numerous variants created, the direct laryngoscope remains one of the salient developments in the storied history on anesthesiology. Success or failure of intubation technique depends on the metrics that we use. Early analysis [4] was binary, success or failure, irrespective of the number of attempts, duration of the effort, amount of force utilized and the laryngeal view obtained. Degree of difficulty was not included. Improved pre-intubation metrics [4] for anatomic airway assessment improved recognition of subjects likely to be problematic. Later analysis [5] focused on ergonomics and the force, both axial and perpendicular, applied by the laryngoscopist, which reached 70% of peak values. Later analysis [4] extending to progressively larger retrospective and prospective sample sizes, was outcome oriented, examining the entire spectrum of resultant major and minor complications, such as: sore throat, dental trauma, trauma to integument, intensive care unit admissions, brain injury, need for a surgical airway or death. DL fails to optimize laryngeal view in up to 6% of patients without apparent anatomic abnormalities, results in mild (38%) and moderate (8%) intubation difficulties and requires more than three intubation attempts in 3% of patients [4]. Subsequent technical advances included the development of the laryngeal mask airway, variants, laryngeal mask airway knock-off devices, supraglottic airways and more recently, the development of the VL. Technological advances are numerous [6]; some milestones include development of the light-emitting diode, liquid crystal display screen, complementary metal-oxide-semiconductor video chip technology, rendering these devices, commercially affordable, more dependable, easier to use and in some cases autoclavable. Some types of the VL are the flexible fiberoptic bronchoscope, flexible, malleable and rigid optical stylets, disposable optical laryngoscopes, channeled, unchanneled and Macintosh-like and hyper-angulated devices. These modern devices offer ...

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