Complications of Atrial Fibrillation/Flutter Ablation
What are the risks of catheter ablation (CA) of atrial fibrillation/flutter (AF/Fl) in Germany?
The data for this study were obtained by interrogation of a large administrative database in Germany. There were 33,385 patients who underwent CA of AF/Fl in 2014. The patients were categorized based on the ablation energy, the atrial chamber in which CA was performed, and the type of atrial arrhythmia. Major complications were defined as in-hospital death, pericardial effusion requiring drainage, stroke, pneumonia, access site complication with need for transfusion, phrenic nerve injury, cardiac arrest, and 3° atrioventricular block.
The prevalence of a major complication ranged from a low of 3.8% in patients undergoing cryoablation to a high of 7.4% in patients undergoing only right atrial ablation. The overall complication rates ranged from 10.5% to 13.8%. The prevalence of in-hospital death was significantly higher following right atrial ablation (0.34%) than following left atrial ablation (0.09%). The risk of overall complications was significantly higher at low-volume centers (<100 left atrial ablations/year) than at higher-volume centers (16.4% vs. 12.7%).
The risk of complications of CA of AF/Fl was higher than generally reported in 2014 in Germany and was in part associated with operator experience.
The complication rates reported in this study are higher than in many other reports in which the major complication rate was 1-8%. Perhaps there simply was more complete documentation of all complications in this study. Overcoding within the administrative database also is a possibility. Also, most of the prior studies came from academic centers with expert operators, whereas this study included many community hospitals with a lower prevalence of expert operators.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Pericardial Disease, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias
Keywords: Arrhythmias, Cardiac, Atrial Flutter, Atrial Fibrillation, Atrioventricular Block, Catheter Ablation, Cryosurgery, Heart Arrest, Hospital Mortality, Pericardial Effusion, Pneumonia, Secondary Prevention, Stroke, Vascular Diseases
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