Analysis of Complications in 1000 Consecutive Radiofrequency Catheter Ablations of Atrial Fibrillation
Introduction. In patients with drug-refractory symptomatic atrial fibrillation (AF), radiofrequency catheter ablation has become the main treatment option. Despite advances in technology and experience, the incidence of complications for this procedure reported by researchers still varies. In the USA, irrigated catheters are used nearly always, mostly with contact force sensing. We used conventional catheters.
The aim. To analyze the complications in 1000 consecutive radiofrequency catheter ablations of atrial fibrillation.
Results and discussion. Non-irrigated 4 mm tip ablation catheters and two venous punctures were used. In total, 32 (3.2%) complications were observed. Pericardial tamponade was observed in 6 cases (0.6%), pericardial effusion in 7 (0.7%), pericardial puncture without effusion in 1 (0.1%), pericarditis in 1 (0.1%), complete atrioventricular (AV) block in 2 (0.2%), transient AV block in 1 (0.1%), stroke in 2 (0.2%), diaphragm paresis with pneumonia in 1 (0.1%), femoral artery aneurysm in 6 (0.6%), femoral hematoma requiring blood transfusion in 2 (0.2%), arteriovenous fistula in 2 (0.2%), hematuria in 1 (0.1%).
Similar frequency of iatrogenic AV block was reported in the literature.
There were 26 (3.4%) complications during 794 primary procedures. After 206 repeated procedures, we observed 2 femoral hematomas, 2 femoral artery aneurysms, 1 arteriovenous fistula and 1 complete AV block – a total of 6 (2.9%) complications.
In several reports the incidence of life-threatening complications was lower than that in our study. However, the total number of complications in our group is at the level of the best results, despite the fact that we do not use irrigated catheters, esophageal temperature probes and endovascular ultrasound probes.
Conclusions. The technique that we use is as safe as other methods of AF radiofrequency catheter ablation.
- Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2021 Feb 1;42(5):373-498. https://doi.org/10.1093/eurheartj/ehaa612.
- Deshmukh A, Patel NJ, Pant S, Shah N, Chothani A, Mehta K, et al. In-hospital complications associated with cath- eter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation. 2013 Nov 5;128(19):2104-2112. https://doi.org/10.1161/CIRCULATIONAHA.113.003862.
- Voskoboinik A, Sparks PB, Morton JB, Lee G, Joseph SA, Hawson JJ, et al. Low rates of major complications for radiofrequency ablation of atrial fibrillation maintained over 14 years: a single centre experience of 2750 con- secutive cases. Heart Lung Circ. 2018 Aug;27(8):976-983. https://doi.org/10.1016/j.hlc.2018.01.002.
- Loring Z, Holmes DN, Matsouaka RA, Curtis AB, Day JD, Desai N, et al. Procedural Patterns and Safety of Atrial Fibrillation Ablation: Findings From Get With The Guidelines-Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2020 Sep;13(9):e007944. https://doi.org/10.1161/CIRCEP.119.007944.
- Steinbeck G, Sinner MF, Lutz M, Müller-Nurasyid M, Kääb S, Reinecke H. Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014. European Heart Journal. 2018 Dec 1;39(45):4020-4029. https://doi.org/10.1093/eurheartj/ehy452.
- Doronin A, Suslina J, Riznyk A, Khanenova V, Marushko Y, Meshkova M. [The safety evaluation of the atrial fibrilla- tion radiofrequency catheter ablations with non-irrigated 4 mm tip catheters use]. Cardiovascular Surgery Herald. 2017;(3 (29)):80-82. Russian. https://doi.org/10.30702/ujcvs/17.29/15(080-082).
- Abdur Rehman K, Wazni OM, Barakat AF, Saliba WI, Shah S, Tarakji KG, et al. Life-Threatening Complications of Atrial Fibrillation Ablation: 16-Year Experience in a Large Prospective Tertiary Care Cohort. JACC: Clinical Electrophysiology. JACC Clin Electrophysiol. 2019 Mar;5(3):284-291. https://doi.org/10.1016/j.jacep.2018.11.013.
- Doronin A, Suslina Y, Riznyk A, Khanenova V, Marushko Y, Meshkova M. [Pulmonary veins isolation with non-irri- gated ablation catheters]. Cardiovascular Surgery Herald. 2018;(4 (33)):64-66. Russian. https://doi.org/10.30702/ujcvs/18.33/16(064-066)
- Doronin A, Suslina Y, Riznyk A, Khanenova V, Marushko Y, Meshkova M. [Radiofrequency catheter ablation of non-paroxysmal atrial fibrillation]. Cardiovascular Sur- gery Herald. 2018;(2(31)):106-108. Russian. https://doi.org/10.30702/ujcvs/18.31/24(106-108).
- Kautzner J, Albenque JP, Natale A, Maddox W, Cuoco F, Neuzil P, et al. A Novel Temperature-Controlled Radio-frequency Catheter Ablation System Used to Treat Patients With Paroxysmal Atrial Fibrillation. JACC Clin Electrophysiol. 2021 Mar;7(3):352-363. https://doi.org/10.1016/j.jacep.2020.11.009.