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Procedure-Related Complications of Catheter Ablation for AF
Quick Takes
- A meta-analysis of randomized clinical trials, which enrolled patients undergoing their first atrial fibrillation ablation procedure showed the overall rate of complications to be 4.5%. Severe procedure-related complication rate was 2.4%; pericardial effusion or tamponade rate was 0.8%; and stroke/TIA rate was 0.2%.
- The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.8% vs. 5.3%, statistically significant).
Study Questions:
What is the rate of procedure-related complications associated with catheter ablation of atrial fibrillation (AF)?
Methods:
The authors searched publication databases looking for randomized clinical trials (RCTs), which included patients undergoing their first AF ablation procedure with either radiofrequency or cryoablation.
Results:
A total of 89 studies enrolled 15,701 patients. The overall rate of complications was 4.5%; the severe procedure-related complication rate was 2.4%; vascular complication rate was 1.3%; pericardial effusion or tamponade rate was 0.8%; and stroke/transient ischemic attack (TIA) rate was 0.2%. The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.8% vs. 5.3%, statistically significant). The pooled mortality rate was stable over the two time periods (0.06% vs. 0.05%, p = NS). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation.
Conclusions:
The authors conclude that the procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade.
Perspective:
There has been widespread adoption of AF ablation procedures in the last decade, as the number of operators and training programs has increased. The current meta-analysis shows that the risk of complications from catheter ablation of AF is low, and that it has decreased in the last decade. Interestingly, the choice of energy source and ablation strategy, e.g., the creation of additional ablation lesions beyond the pulmonary vein antra, did not appear to impact the rate of adverse events. Because the RCTs were likely done at centers of excellence, it is uncertain whether these findings would be representative of low-volume centers.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Pericardial Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Cardiac Tamponade, Catheter Ablation, Cryosurgery, Ischemic Attack, Transient, Pericardial Effusion, Radiofrequency Ablation, Stroke, Vascular Diseases
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