Skin Burn at the Site of Indifferent Electrode after Radiofrequency Catheter Ablation of AV Node for Atrial Fibrillation.

Abstract

IntroductionRadiofrequency (RF) energy is a low voltage high frequency electrical energy which produces controlled focal tissue ablation. It has revolutionised the treatment of refractory supraventricular tachycardias. Although radiofrequency catheter ablation (RFCA) is a safe procedure, application of RF energy is not without complications. Major complications may occur in up to 3% of patients undergoing RFCA which includes AV block, Cardiac tamponade, Coronary artery spasm, thrombosis, Pericarditis, Vascular Injury, Thromboembolism, Transient ischemic attack and or stroke, Pulmonary hypertension secondary to pulmonary vein stenosis, Pneumothorax, Left atrial-esophageal fistula and Phrenic nerve paralysis1. Most of the complications of RF ablation of supraventricular arrhythmias are limited to the site of RF energy application and skin burn at the indifferent electrode site was described in only case secondary to maladhesion2 of the electrode pads. We present a case of skin burn at the site of indifferent electrode after an elective RF ablation for recurrent AF. Case ReportA 54 year old white obese woman (BMI 43) with 8 year history of symptomatic paroxysmal atrial fibrillation was referred for AV nodal ablation and permanent pacemaker insertion. Her past medical history is significant for hypertension and aortic valve replacement (#19 St. Jude Prosthetic valve) for congenital bicuspid aortic valve 9 years ago. She had multiple cardioversions and was treated with multiple antiarrhythmic drugs to achieve rhythm restoration. But AF remained unresponsive and she was symptomatic with fatigue, dys- AbstractRadiofrequency Ablation of AV node with permanent pacemaker has been used to achieve rate control in persistent symptomatic atrial fibrillation. Although RF Ablation is safe, complications may occur in up to 3% of the procedures. A rare complication of 2nd degree skin burn at indifferent electrode site has been described here. This report highlights the rare but possible complication in patients undergoing such a procedure and help in preventing by taking appropriate measures.

Third-degree full-thickness burns as a complication of cervical radiofrequency ablation

“…Potential adverse events (AEs) are rarely reported but may include painful cutaneous hyperesthesia, dysesthesias and increased pain 4 5. Some reports suggest that cervical RFA can interfere with implantable electronic devices, such as stimulators or defibrillators; can cause dropped head syndrome; ataxia; or neuromuscular instability, and therefore, it is imperative to follow best practice recommendations to minimise the risk of AEs 9 10.…”

“…Most commonly complications from RFA occur following solid tumour ablations and are less common following spinal (cervical, thoracic and lumbar) RFA. Complications include short-term paresthesias, worsening pain and skin burns, which are more common following cardiac or tumour RFA, while other spinal RFA procedures have relatively little incidence of burns 4 5. Third-degree full-thickness burns are a rare complication after RFA procedures, with an estimated incidence ranging between 0.1% and 3.2% 4.…”

Incidence and Factors Predicting Skin Burns at the Site of Indifferent Electrode during Radiofrequency Catheter Ablation of Cardiac Arrhythmias

“…Increase of temperature at the catheter tip is the foundation of the therapy with RFA as it causes the local destruction of the tissue. Dispersive skin pads at the site of the indifferent electrode function to disperse the electrical energy exiting the body and thus prevent the occurrence of skin burns by spreading the energy over a larger surface area [ 3 ]. In prior studies, it has been predicted that the temperature rises to 45–47°C.…”

“…Up to 3% of patients undergoing radiofrequency catheter ablation develop major complications from the procedure. These complications include AV block, cardiac tamponade, coronary artery spasm, thrombosis, pericarditis, vascular injury, thromboembolism, TIA or stroke, pulmonary hypertension, pneumothorax, left atrial-esophageal fistula, and phrenic nerve paralysis [ 3 ]. Skin burns at the site of an indifferent electrode patch have been a rare, serious, and likely an underreported complication of RFA [ 4 , 5 ].…”

Radiofrequency catheter ablation of cardiac arrhythmias: Don’t get burned

“…Indeed, we identified only 5 other published reports on this subject, with a total of 12 patients sustaining burns. 4 , 5 , 6 , 7 , 8 In reality, this complication is likely under-reported, and the true incidence is difficult to ascertain. The most comprehensive publication, to our knowledge, reported a skin burn incidence of 0.28% (6 out of 2167 consecutive RFA procedures).…”