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Complications in Catheter Ablation of Atrial Fibrillation in 3,000 Consecutive Procedures

Complications in Catheter Ablation of Atrial Fibrillation in 3,000 Consecutive Procedures

Authors :
K.R. Julian Chun
Alexander Fürnkranz
Athanasios Konstantinou
Daniela Dugo
Boris Schmidt
Jan Khalil
Laura Perrotta
Stefano Bordignon
Source :
JACC: Clinical Electrophysiology. 3:154-161
Publication Year :
2017
Publisher :
Elsevier BV, 2017.

Abstract

Objectives The aim of this study was to identify predictors of cardiac tamponade (CT) during atrial fibrillation (AF) ablation using different technologies and strategies. Background The major cause of death during catheter ablation of AF is related to CT. The risk for CT may be linked to different procedural steps (transseptal puncture, catheter manipulation during left atrial and pulmonary vein mapping and ablation). Methods All AF ablation procedures undertaken from May 2010 to July 2015 at a single center were included. Two ablation groups were defined: group A, radiofrequency current, and group B, balloon. Group A was divided into groups A1 (pulmonary vein isolation [PVI] only) and A2 (PVI plus additional ablation). In group A, 2 transseptal punctures were performed, followed by wide-area circumferential point-by-point PVI (group A1) within a 3-dimensional left atrial map and complex fractionated atrial electrograms and/or linear lesions (group A2). In group B, 1 transseptal puncture by balloon-based PVI (cryoballoon, laser balloon). All episodes of CT were analyzed. Results In total, 3,000 AF ablation procedures were performed, 2,125 in group A (group A1, n = 1,559; group A2, n = 566) and 875 in group B (cryoballoon, n = 589; laser balloon, n = 286). The rate of CT was 1.1% (32 of 3,000) and was significantly lower in group B than in group A: 0.1% (1 of 875) versus 1.5% (31 of 2,125) (p = 0.001). The reduced CT risk remained if PVI only (group B vs. group A1) was compared: 0.8% (13 of 1,559) versus 0.1% (1 of 875) (p = 0.024). The greatest CT risk was seen in group A2: 3.2% (18 of 566). Radiofrequency current ablation beyond PVI was a predictor of CT. Conclusions The risk for CT in patients undergoing AF ablation at a single high-volume center was decreased with the use of balloon catheters. Extensive radiofrequency current ablation beyond PVI leads to an increased perforation risk.

Details

ISSN :
2405500X
Volume :
3
Database :
OpenAIRE
Journal :
JACC: Clinical Electrophysiology
Accession number :
edsair.doi...........ceb41e47ba81acf51a287c6fa4601f0e
Full Text :
https://doi.org/10.1016/j.jacep.2016.07.002