Predictors of Cardiac Perforation With Catheter Ablation of Atrial Fibrillation

Friedman, Daniel J.; Pokorney, Sean D.; Ghanem, Amer; Marcello, Stephen; Kalsekar, Iftekhar; Yadalam, Sashi; Akar, Joseph G.; Freeman, James V.; Goldstein, Laura; Khanna, Rahul; Piccini, Jonathan P.

doi:10.1016/j.jacep.2020.01.011

Cited by 49 publications

(49 citation statements)

References 17 publications

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“…Routine use of vascular ultrasound for femoral venous access may be effective at closing this gap 33,34 . Similarly, small left atrial diameter in women has been invoked as a potential cause for increased rates of pericardial effusion/tamponade related to trans‐septal puncture and routine use of ICE may be useful for this reason 3,10 . Although routine use of ICE has been associated with a significantly lower rate of pericardial complications, cost considerations limit its routine use outside the United States 10 and these geographic differences need to be taken into account when evaluating individual studies reporting AFCA complication rates.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, small left atrial diameter in women has been invoked as a potential cause for increased rates of pericardial effusion/tamponade related to trans‐septal puncture and routine use of ICE may be useful for this reason 3,10 . Although routine use of ICE has been associated with a significantly lower rate of pericardial complications, cost considerations limit its routine use outside the United States 10 and these geographic differences need to be taken into account when evaluating individual studies reporting AFCA complication rates. It is also possible that a higher prevalence of non‐pulmonary vein triggers may result in additional ablation in women, 6 which may also increase the risk of cardiac perforation and tamponade 35 .…”

Section: Discussionmentioning

confidence: 99%

“…Eligible studies included those reporting procedural complications from AFCA in patients >18 years old, stratified by sex, and published from January 1, 2010 until January 1, 2020. The year 2010 was chosen as the beginning date for inclusion to correspond with the emergence of data supporting contemporary strategies to enhance AFCA safety including uninterrupted anticoagulation 9 as well as the wider availability of phased‐array intracardiac echocardiography (ICE) 10,11 . Surgical AF ablation studies were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…The year 2010 was chosen as the beginning date for inclusion to correspond with the emergence of data supporting contemporary strategies to enhance AFCA safety including uninterrupted anticoagulation 9 as well as the wider availability of phased-array intracardiac echocardiography (ICE). 10,11 Surgical AF ablation studies were excluded. Only randomized trials, prospective or retrospective cohort studies were included.…”

Section: Eligibility Criteriamentioning

confidence: 99%

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Sex‐based differences in procedural complications associated with atrial fibrillation catheter ablation: A systematic review and meta‐analysis

Campbell

Larson

Westerman

et al. 2020

Cardiovasc electrophysiol

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Background: Women undergoing atrial fibrillation catheter ablation (AFCA) have higher rates of vascular complications and major bleeding. However, most studies have been underpowered to detect differences in rarer complications such as stroke/transient ischemic attack (TIA) and procedural mortality. Methods: We performed a systematic review of databases (PubMed, World of Science, and Embase) to identify studies published since 2010 reporting AFCA complications by sex. Six complications of interest were (1) vascular/groin complications; (2) pericardial effusion/tamponade; (3) stroke/TIA; (4) permanent phrenic nerve injury; (5) major bleeding; and (6) procedural mortality. For meta-analysis, random effects models were used when heterogeneity between studies was ≥50% (vascular complications and major bleeding) and fixed effects models for other endpoints. Results: Of 5716 citations, 19 studies met inclusion criteria, comprising 244,353 patients undergoing AFCA, of whom 33% were women. Women were older (65.3 ± 11.2 vs. 60.4 ± 13.2 years), more likely hypertensive (60.6% vs. 55.5%) and diabetic (18.3% vs. 16.5%), and had higher CHA 2 DS 2-VASc scores (3.0 ± 1.8 vs. 1.4 ± 1.4) (p < .0001 for all comparisons). The rates of all six complications were significantly higher in women. However, despite statistically significant differences, the overall incidences of major complications were very low in both sexes: stroke/ TIA (women 0.51% vs. men 0.39%) and procedural mortality (women 0.25% vs. men 0.19%). Conclusion: Women experience significantly higher rates of AFCA complications. However, the incidence of major procedural complications is very low in both sexes. The higher rate of complications in women may be partially attributable to older age and a higher prevalence of comorbidities at the time of ablation. More detailed studies are needed to better define the mechanisms of increased risk in women and to identify strategies for closing the sex gap.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Eligibility Criteriamentioning

confidence: 99%

See 2 more Smart Citations

Sex‐based differences in procedural complications associated with atrial fibrillation catheter ablation: A systematic review and meta‐analysis

Campbell

Larson

Westerman

et al. 2020

Cardiovasc electrophysiol

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“…Friedman et al analyzed predictors of cardiac perforation in a nationwide registry of 102,398 patients undergoing atrial brillation (AF) ablation. In this registry, ICE was used in 73% of patients, and the absence of ICE use was associated with a signi cantly higher rate of cardiac perforation (odds ratio: 4.85; 95% con dence interval: 4.11 to 5.71; p < 0.0001) [14]. However, ICE is expensive, Also, ICE requires further vascular access, The resolution of ICE is lower than that of TEE, and young operators need a certain amount of learning time to master this technology.…”

Section: Publication Biasmentioning

confidence: 97%

Intracardiac Versus Transesophageal Echocardiography for diagnosis of Left Atrial Appendage Thrombosis in Atrial Fibrillation: a Meta-analysis

Liu

Huang

et al. 2021

Preprint

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Introduction: Left atrial appendage (LAA) thrombus in patients with atrial fibrillation is usually detected by transesophageal echocardiography (TEE). Intracardiac echocardiography (ICE) can be a suitable alternative to detect thrombosis. We performed a meta-analysis of all studies that compared ICE vs. TEE for LAA thrombosis.Methods: We searched PubMed, Cochrane Library, and Embase for published abstracts and manuscripts until June 1, 2020. Studies reporting clinical outcomes comparing TEE vs. ICE for LAA thrombus in human subjects aged ≥ 18 years were included. Two investigators independently extracted the data and an individual quality assessment was performed. The analysis was performed using RevMan 5.3, STATA 15, and Meta-Disc 1.4.Results: Eight eligible studies consisting of 1108 patients (TEE = 558 vs. ICE = 550) were included. The average sensitivity of ICE and TEE to diagnose left atrial appendage thrombus was 1.0 (95% CI: 0.91-1.00) vs 0.68 (95% CI: 0.49-0.83),and specificity of ICE and TEE to diagnosis of left atrial appendage thrombus was 1.0 (95% CI: 0.99-1.00) vs 0.98 (95% CI: 0.96-0.99) . The AUC of ICE and TEE were 0.9846 (SEAUC = 0.0196) and 0.9655 (SEAUC = 0.0401), and the Q * statistics were 0.9462 (SEQ * = 0.0406) and 0.9127 (SEQ * = 0.0616), respectively. Z test was performed on Q * statistics (Z = 0.45, P> 0.05), there was no significant difference between ICE and TEE.Conclusion: ICE and TEE have similar diagnostic efficacy for left atrial appendage thrombosis, but ICE has higher sensitivity and specificity, which has certain advantages over TEE and has clinical application prospects.

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Impact of obesity on catheter ablation of ventricular tachycardia: In‐hospital and 30‐day outcomes

Tan

Yeo

Ang

et al. 2023

Journal of Arrhythmia

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BackgroundEvidence on the impact of obesity on catheter ablation for ventricular tachycardia (VT) is scarce.Method and ResultsWe queried the Nationwide Readmissions Database to determine the hospital outcomes and procedural complications of VT ablation among the obese and nonobese populations. Obesity was associated with a more prolonged length of stay (p < .01), higher cost of hospitalization (p < .01), and higher rates of pericardial effusion or hemopericardium (p = .05) and vascular complications (p = .05). There was no significant difference in early mortality, 30‐day readmissions, and other procedural complications.ConclusionVT ablation could be performed relatively safely among patients with obesity.

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Predictors of Cardiac Perforation With Catheter Ablation of Atrial Fibrillation

Cited by 49 publications

References 17 publications

Sex‐based differences in procedural complications associated with atrial fibrillation catheter ablation: A systematic review and meta‐analysis

Sex‐based differences in procedural complications associated with atrial fibrillation catheter ablation: A systematic review and meta‐analysis

Intracardiac Versus Transesophageal Echocardiography for diagnosis of Left Atrial Appendage Thrombosis in Atrial Fibrillation: a Meta-analysis

Impact of obesity on catheter ablation of ventricular tachycardia: In‐hospital and 30‐day outcomes

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