Predictors of Early Complications of AF Ablation | Journal Scan

Apr 10, 2015
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Authors:
Inoue K, Murakawa Y, Nogami A, et al.
Citation:
Clinical and Procedural Predictors of Early Complications of Ablation for Atrial Fibrillation: Analysis of the National Registry Data. Heart Rhythm 2014;11:2247-2253.
Summary By:
Fred Morady, MD, FACC

Study Questions:

What factors are predictive of a complication after catheter ablation of atrial fibrillation (AF)?

Methods:

The data for this study were obtained from a registry of 3,373 AF ablation procedures performed in 2011-2012 at 165 centers in Japan.

Results:

A periprocedural complication occurred in 4.5% of patients. The independent predictors of a complication were: valvular heart disease (odds ratio [OR], 2.53), hypertrophic cardiomyopathy (OR, 2.2), ablation of complex atrial electrograms (OR, 1.88), female gender (OR, 1.6), and deep sedation (OR, 1.53). A lower risk of a complication was predicted by a preprocedural transesophageal echocardiogram (OR, 0.63), periprocedural use of a novel oral anticoagulant (OR, 0.55), and use of an irrigated-tip catheter (OR, 0.46).

Conclusions:

The risk of an early complication in patients undergoing catheter ablation of AF is increased by female gender, hypertrophic cardiomyopathy, valvular heart disease, deep sedation, and ablation of complex atrial electrograms. The risk is diminished by preprocedural transesophageal echocardiography, periprocedural novel oral anticoagulant use, and irrigated-tip catheter use.

Perspective:

The 4.5% complication rate in this registry is similar to the complication rates reported in prior registries of patients undergoing AF ablation. However, several of the predictors identified in prior studies were not confirmed in this study. These include older age, high CHADS2 score, congestive heart failure, and coronary artery disease. As would be expected, a low-volume operator also has been found to be a risk factor in prior studies. For unclear reasons, this obvious risk factor was not confirmed in the present study, perhaps reflecting an inherent limitation of voluntary registry studies.

Keywords: Atrial Fibrillation, Anticoagulants, Cardiomyopathy, Hypertrophic, Catheter Ablation, Deep Sedation, Echocardiography, Transesophageal, Electrophysiologic Techniques, Cardiac, Heart Failure, Registries, Risk, Risk Factors


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