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Incidence and Predictors of Major Complications From Contemporary Catheter Ablation to Treat Cardiac Arrhythmias
Study Questions:
What are the major risks of catheter ablation?
Methods:
Major complications were noted prospectively in 1,676 patients (mean age 57.6 years) undergoing catheter ablation for supraventricular tachycardia (SVT) (n = 524), atrial fibrillation (AF) (n = 784), and ventricular tachycardia (VT) in the presence of structural heart disease (SHD) (n = 250), and idiopathic VT (n = 118).
Results:
The overall rate of major complications was 3.8%, ranging from 0.8% for SVT ablation to 5.2% for AF ablation and 6% for VT ablation in patients with SHD. A fatal complication (stroke or retroperitoneal hemorrhage) occurred in two patients (0.1%). The most common complications were access-related femoral vascular complications (1.4%), cardiac tamponade (0.7%), stroke (0.6%), and pericardial effusion without tamponade (0.5%). There were four independent predictors of a major complication: VT in the presence of SHD (odds ratio [OR], 8.6), idiopathic VT (OR, 5.9), AF (OR, 2.5), and a serum creatinine >1.5 mg/dl (OR, 2.5).
Conclusions:
The authors concluded that the risk of major complications during contemporary catheter ablation depends on the target arrhythmia, with a range of 0.8% for SVT ablation to 6% for VT ablation in the presence of SHD.
Perspective:
Based on this and prior studies, it appears that the risk of cardiac tamponade has not decreased over the past 10-15 years and continues to be in the range of 0.5-1%, even in the hands of experienced operators. However, two major complications of ablation, namely atrioventricular block requiring a permanent pacemaker and pulmonary vein stenosis, were notably absent in this study. This likely is a reflection of operator experience and indicates that these complications generally are avoidable.
Keywords: Heart Diseases, Atrioventricular Block, Incidence, Stroke, Pacemaker, Artificial, Heart Rate, Catheter Ablation, Pericardial Effusion, Cardiac Tamponade, Tachycardia
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