Prevalence and Predictors of Complications of Radiofrequency Catheter Ablation for Atrial Fibrillation

Abstract

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.

Catheter Ablation of Lone Atrial Fibrillation

“…There is consistency of the data from several studies on the increased procedural risk in women [127,[130][131][132]]. An analysis of 517 AF ablation procedures showed that female gender was an independent predictor of major complications (OR 3.…”

“…Higher vascular complication rate also occurs with inexperienced operators at the start of the electrophysiological training [130]. Occurrence of vascular complications could be minimized with careful vascular access, manual hemostasis and observation of puncture site after the intervention.…”

“…Among patients treated with catheter ablation of AF, 10-25% were subjected to the repeated procedure [120]. In one study, history of previous RF ablation of AF was associated with increased probability of cardiac tamponade at the redo procedure (OR 3.32 [95% CI: 0.95 to 11.61]; p<0.05), which could be related to scarring and thinning of the LA wall after the first RF ablation [130].…”

“…Women, older and obese patients, diabetics and patients subjected to repeated procedures could be particularly prone to occurrence of vascular complications [130].…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…252,289,290,291,806,808,920,1050,1051,1052,1053,1054,1056,1057,1058,1059 A multicenter U.S. retrospective study reported total complications of 3265 (518 in women vs 2747 in men), with a 5% complication rate in women vs 2.4% in men ( P <.001). This study found more hematomas and pseudoaneurysms in women.…”