Severe Periprocedural Complications After Ablation for Atrial Fibrillation: An International Collaborative Individual Patient Data Registry
Background: Catheter ablation for atrial fibrillation (AF) including pulmonary vein (PV) isolation (PVI) and possibly further substrate ablation is the most common electrophysiological procedure. Severe complications are uncommon but their detailed assessment in a large worldwide cohort is lacking.
Methods: We collected individual patient-data from 23 centers worldwide. Limited data was collected for all patients who underwent catheter ablation and expanded series of datapoints were collected for patients who experienced a severe complication during periprocedural follow-up. We investigated the incidence, predictors, patient characteristics, management details and overall outcomes of patients who suffered ablation-related complications.
Results: Data were collected from 23 participating centers where 33,879 procedures were performed (median age 63 years, 30% female, 71% radiofrequency ablations). The incidence of severe complications (n=271) was low (tamponade 6.8‰, stroke 0.97‰, cardiac arrest 0.41‰, oesophageal fistula 0.21‰, death 0.21‰). Age, female sex, a dilated left atrium, procedure duration and the use of radiofrequency energy were independently associated with the composite endpoint of all severe complications. Among the patients experiencing a tamponade, 13% required cardiac surgery. 93% of patients with a complication were discharged directly home after a median length of stay of 5 days (IQR 3-7).
Conclusion: This large worldwide collaborative study highlighted that tamponade, stroke, cardiac arrest, oesophageal fistula or death are rare after AF ablation. Older age, female sex, procedure duration, a dilated LA and the use of radiofrequency energy were associated with severe complications in our multinational cohort. One in eight patients with tamponade required cardiac surgery.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Author
Kelvin N.V. Bush, MD, FACC, CCDS
Important Dates
Date of Release: July 22, 2024
Term of Approval/Date of CME/MOC Expiration: July 21, 2025