Catheter Ablation For Atrial Fibrillation: What is the Risk of Procedural Complications?

Catheter ablation of atrial fibrillation (AFib) is a common procedure associated with potentially significant procedure-related complications, but the rate of these complications as well as mortality are low and decreased over the past decade, according to a systematic review and pooled analysis published May 22 in JACC.

Karim Benali, MD, et al., conducted a systematic review and pooled analysis using data from 89 randomized controlled trials with a total of 15,701 patients in the MEDLINE or EMBASE databases in which patients underwent a first ablation procedure for AFib using either radiofrequency or a cryoballoon from January 2013 to September 2022. They examined the rate of procedure-related complications within one year of the procedure date.

Results showed that the rate of overall procedure-related complications was 4.51% (95% CI, 3.76%-5.32%) and severe procedure-related complications was 2.44% (95% CI, 1.98%-2.93%), with vascular complications being the most common (1.31%).

Procedure-related death occurred in nine patients (0.06%). Of these nine patients, six died as a result of an atrioesophageal fistula, two died due to a stroke and one died of an uncertain cause.

The current analysis showed that in terms of temporal trends, the rate of procedure-related complications during the most recent five-year period was significantly lower than that in initial five-year period (3.77% vs. 5.31%; p=0.043). The pooled mortality rate remained stable throughout both five-year periods (0.06% vs. 0.05%; p=0.892). Demographic factors such as age, gender and body mass index did not have a significant effect on procedural outcomes.

The authors stated there was no significant difference in the complication rate in relation to the pattern of AFib, ablation modality or ablation strategies.

In an accompanying editorial comment, Kevin J. Ferrick, MD, FACC, writes that the management of AFib has been questioned for decades and that “this report yields clinically important information allowing the clinician and patient to make a more informed decision regarding choosing ablation.” However, he writes that it remains unclear how individual patient characteristics such as race, ethnicity and socioeconomic determinants affect the risk of procedure-related complications and long-term outcomes. Ferrick also notes that the review by Benali, et al., included only randomized studies, which are most often performed in high-volume, academically oriented centers, and that complication rates may differ substantially in a community-based setting with a more diverse population.

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

Keywords: Fistula, Catheter Ablation, MEDLINE, Atrial Fibrillation

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