Incidence and Predictors of Major Complications From Contemporary Catheter Ablation to Treat Cardiac Arrhythmias
What are the major risks of catheter ablation?
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).
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).
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.
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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