Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern?
Open accessAbstract
INTRODUCTION: Catheter ablation is potentially curative treatment for atrial fibrillation (AF). However, complications are more frequent and more severe compared with other ablation procedures. We investigated the complication rate in 1,000 AF ablation procedures in a high-volume center and examined possible risk factors. METHODS AND RESULTS: One thousand consecutive circumferential pulmonary vein radiofrequency ablations were performed for symptomatic, drug-refractory AF. Major complications were defined as the ones that were life threatening, caused permanent harm, and required intervention or prolonged hospitalization. Thirty-nine (3.9%) major periprocedural complications were observed. There was no death immediately associated with the procedure. However, there were 2 deaths (0.2%) of unclear cause, 14 days and 4 weeks after ablation. The most common complications were tamponade (1.3%), treated mainly by percutaneous drainage, and vascular complications (1.1%). There were also 4 thromboembolic events (0.4%): 3 nonfatal strokes and one transient ischemic attack. Importantly, 2 cases (0.2%) of atrial-esophageal fistula and 2 cases (0.2%) of endocarditis were observed. Factors associated with an increased complication risk were age > or = 75 years (hazard ratio 3.977, P = 0.022) and congestive heart failure (hazard ratio 5.174, P = 0.001). CONCLUSION: AF ablation still has a considerable number of major complications that may be life threatening or may lead to severe residues. Atrial-esophageal fistula is still observed despite continuous systematic methods to prevent it. Stroke, tamponade, and vascular complications are the most frequent major complications. However, in most patients treatment can be conservative and results in complete recovery. Advanced age and congestive heart failure seem to be associated with an increased risk of complications.
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Five to seven per cent of patients will suffer severe complications after catheter ablation of atrial fibrillation, and 2-3% will experience life-threatening but usually manageable complications.
“Five to seven per cent of patients will suffer severe complications after catheter ablation of AF, and 2-3% will experience life-threatening but usually manageable complications.727,[748][749][750]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [748]
Timely detection of atrio-oesophageal fistulas can be life-saving.
“Timely detection of atrio-oesophageal fistulas can be life-saving and should be based on the typical triad of infection without a clear focus, retrosternal pain, and stroke or TIA.748”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [748]
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- Authors
- DAGRES, N., HINDRICKS, G., KOTTKAMP, H., SOMMER, P., GASPAR, T., BODE, K., ARYA, A., HUSSER, D., RALLIDIS, L. S., KREMASTINOS, D. T., & PIORKOWSKI, C.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- Leipzig University (DE)
- Klinik Hirslanden (CH)
- Corresponding author
- DAGRES, NIKOLAOS
- ORCID
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2009-08-26
- Volume
- 20
- Issue
- 9
- Pages
- 1014-1019
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2169638820
- Cited by
- 279
- References
- 28
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 7 · 2023: 7 · 2022: 10 · 2021: 17 · 2020: 14 · 2019: 18 · 2018: 14 · 2017: 20 · 2016: 17 · 2015: 22 · 2014: 28 · 2013: 28 · 2012: 23
- FWCI
- 16.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, catheter ablation, radiofrequency ablation, pulmonary vein ablation, procedural complications, tamponade, vascular complications, stroke, atrial-esophageal fistula, endocarditis, thromboembolism, risk factors, old age, congestive heart failure, high-volume centers
- MeSH terms
- Atrial Fibrillation, Female, Germany, Humans, Male, Middle Aged, Postoperative Complications, Risk Factors, Comorbidity, Incidence, Survival Rate, Survival Analysis, Treatment Outcome, Catheter Ablation, Risk Assessment
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