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

Dec 23, 2011
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Authors:
Hoyt H, Bhonsale A, Chilukuri K, et al.
Citation:
Heart Rhythm 2011;8:1869-1874.
Summary By:
Fred Morady, MD, FACC

Study Questions:

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

Methods:

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.

Results:

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).

Conclusions:

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

Perspective:

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.

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


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