Complications Arising From Catheter Ablation of Atrial Fibrillation: Temporal Trends and Predictors

Study Questions:

Does the risk of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) go down as institutional experience increases?


Major complications were tracked in 931 patients who underwent 1,190 RFCA procedures between 2001 and 2010 at a single institution. Major complications consisted of complications that occurred during or within 30 days after RFCA and were life-threatening, resulted either in permanent injury or prolonged hospitalization, or required intervention.


The overall complication rate was 4.7%. The most common complications were femoral vascular complications (1.5%), cardiac tamponade (1.1%), and stroke/transient ischemic attack (1.1%). There were no fatalities. The complication rate decreased significantly over time, dropping from 11.1% in 2002 to 1.6% in 2010. Among nine operators whose caseload varied from 9 to 820, there was no relationship between operator experience and complication rate. The only demographic or clinical variables that were independently associated with the risk of a major complication were a CHADS2 score ≥2 (hazard ratio [HR], 2.5) and female gender (HR, 2.0).


The authors concluded that risk of major complications from RFCA of AF goes down as institutional experience increases.


Many potential major complications of RFCA of AF are operator-dependent, and the paradoxical absence of a relationship between operator experience and complication rate may be attributable to the excellent training of junior attending physicians and/or assistance from senior operators during technically-challenging procedures. The temporal reduction in complications also may be attributable to improved imaging systems, the introduction of irrigated-tip ablation catheters, and safer periprocedural anticoagulation strategies.

Clinical Topics: Arrhythmias and Clinical EP, Pericardial Disease, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Incidence, Stroke, Heart Atria, Ischemic Attack, Transient, Cardiology, Heart Rate, Catheter Ablation, Cardiac Tamponade

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