Complications of Catheter Ablation of Atrial Fibrillation

Abstract

C atheter ablation of atrial fibrillation (AF) is an established rhythm control strategy in symptomatic AF. [1][2][3][4] The procedure aims to eliminate triggers and substrate that initiate, perpetuate, and sustain AF. Because catheter technology improves and experience increases, wider inclusion criteria are being used to select patients. Indeed, selected patients may benefit from ablation as first-line therapy. 5 A recent study reporting the outcomes of 2 meta-analyses found a 77% success rate for catheter ablation versus 52% for antiarrhythmic drugs. 6 Several randomized controlled trials have reported similar results.6-10 A meta-analysis of 4 of these studies found a >3.7-fold probability of freedom from AF with ablation compared with medical therapy. 11 Clinical Perspective on p 1088Catheter ablation can be associated with significant complications. Safety data reported from high-volume single-center series and the results of a recent international survey are inconsistent with regards to the incidence of acute complications ranging from <1% to 6%. [12][13][14][15][16][17] Furthermore, few studies have investigated the relationship between procedural variables and the complication rate. These have been limited to single-center series where low event rates have limited the identification of statistically significant predictors, and the applicability of results to other treatment settings is unclear.12, [14][15][16]18 The purpose of this review was to determine the incidence, temporal trends, and procedural predictors of complications associated with catheter ablation of AF. MethodsA literature search of the electronic databases, MEDLINE and EMBASE, was conducted on 18th June 2012 to identify all relevant studies describing complications of catheter ablation of AF. A detailed search methodology is presented in the online-only Data Supplement. This was supplemented by hand-searching bibliographies of retrieved articles as well as relevant review articles. Study SelectionStudies were eligible for the review if the participants were adults with symptomatic AF undergoing catheter ablation, and if complications were reported. Studies with both prospective and © 2013 American Heart Association, Inc. Gupta et al Complications of AF Ablation 1083retrospective designs were included. Abstracts, case reports, editorials, comments, conference proceedings, meta-analyses, and review articles were excluded. Studies involving surgical ablation, atrioventricular nodal ablation, exclusive right atrial ablation, or ablate-and-pace strategies were excluded. Animal and in vitro studies, as well as studies in languages other than English, were also excluded. Studies were included if there were ≥100 patients in the treatment arm. This minimum number was chosen to increase the likelihood of retrieving the best quality studies, as well as to exclude case reports and small series. These may have otherwise misrepresented the true incidence of rare adverse events by selectively reporting these cases in often niche patient subgroup...

Catheter Ablation for Atrial Fibrillation in Heart Failure Patients

“…The AF catheter ablation peri-procedural major complication rate in this study was 6.3%. Despite the structural changes seen in patients with reduced LVEF, the reported AF catheter ablation complication rate in this meta-analysis is comparable to, though perhaps slightly higher than, AF catheter ablation complication rates reported in a large prospective study (5.2%) and a recent meta-analysis in patients with structurally normal hearts (2.7–3.5%) (36–37). The trend toward higher adverse event rates compared to the rate control group (p=0.17) suggests there may be a price paid for improving the other outcomes measured in this study.…”

Periesophageal vagal nerve injury following catheter ablation of atrial fibrillation: A case report and review of the literature

“…A recently published retrospective analysis of AF catheter ablation (performed in 83,236 patients enrolled in a total of 192 published clinical trials) reported an overall periprocedural complication rate of 2.9%. The majority of the complications were vascular in nature with an incidence of 1.4% 6 . Gastrointestinal (GI) complications following catheter ablation for AF are exceedingly rare.…”

Mitigating the Risk of Microemboli Formation During Irrigated Radiofrequency Catheter Ablation

“…2,3 However, left atrial procedures, even with open irrigation, are associated with a higher prevalence of embolic complications (stroke, transient ischemic attack, asymptomatic cerebral embolism [ACE], and decline in cognitive function). 4,5 ACE lesions can occur during left atrial ablation procedures and have been attributed to microemboli formation. They are considered the largest complication of pulmonary vein isolation procedures.…”