Complications of Atrial Fibrillation/Flutter Ablation

Dec 13, 2018
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Authors:
Steinbeck G, Sinner MF, Lutz M, et al.
Citation:
Incidence of Complications Related to Catheter Ablation of Atrial Fibrillation and Flutter: A Nationwide In-Hospital Analysis of Administrative Data for Germany in 2014. Eur Heart J 2018;39:4020-4029.
Summary By:
Fred Morady, MD, FACC

Study Questions:

What are the risks of catheter ablation (CA) of atrial fibrillation/flutter (AF/Fl) in Germany?

Methods:

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.

Results:

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%).

Conclusions:

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.

Perspective:

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.

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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