Koichi Inoue1, Yuji Murakawa2, Akihiko Nogami3, Morio Shoda4, Shigeto Naito5, Koichiro Kumagai6, Yasushi Miyauchi7, Teiichi Yamane8, Norishige Morita9, Ken Okumura10. 1. Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan. Electronic address: koichi@inoue.name. 2. Fourth Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan. 3. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 4. Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. 5. Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan. 6. Heart Rhythm Center, Fukuoka Sanno Hospital, Fukuoka, Japan. 7. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan. 8. Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan. 9. Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Japan. 10. Division of Cardiology, Hirosaki University of Graduate School of Medicine, Hirosaki, Japan.
Abstract
BACKGROUND: The risk assessment of the complication from atrial fibrillation (AF) ablation is important and needs to be updated. OBJECTIVE: The purpose of this study was to investigate the clinical and procedural factors associated with AF ablation-related early complications. METHODS: The Japanese Heart Rhythm Society invited electrophysiology centers in Japan to register data regarding all AF ablation procedures performed in September 2011, March 2012, and September 2012. Of the 46 putative predictors assessed in the univariate analysis, significant variables (P < .1) were entered into a stepwise logistic regression model for multivariate analysis. RESULTS: Data for 3373 cases were submitted by 165 centers, with 158 early complications reported in 151 patients (4.5%). We identified 13 significant variables in the univariate analysis. Multivariate analysis revealed that 8 (62%) of them were independent predictors of early complications. Female sex (odds ratio and 95% confidence interval 1.6; 1.13-2.27), hypertrophic cardiomyopathy (2.2; 1.08-4.5), valvular heart disease (2.53; 1.28-5.05), deep sedation during the procedure (1.53; 1.09-2.12), and complex fractionated atrial electrocardiogram ablation (1.88; 1.23-2.87) increased early complications. Preprocedural transesophageal echocardiography (0.63; 0.43-0.92), irrigated-tip catheter use (0.46; 0.3-0.69), and periprocedural novel oral anticoagulant use (0.55; 0.32-0.97) decreased them. CONCLUSION: The risk of early complications is increased by female sex, hypertrophic cardiomyopathy, valvular heart disease, deep sedation, and complex fractionated atrial electrocardiogram ablation. It is decreased by preprocedural transesophageal echocardiography, periprocedural novel oral anticoagulant, and irrigated-tip catheter use.
BACKGROUND: The risk assessment of the complication from atrial fibrillation (AF) ablation is important and needs to be updated. OBJECTIVE: The purpose of this study was to investigate the clinical and procedural factors associated with AF ablation-related early complications. METHODS: The Japanese Heart Rhythm Society invited electrophysiology centers in Japan to register data regarding all AF ablation procedures performed in September 2011, March 2012, and September 2012. Of the 46 putative predictors assessed in the univariate analysis, significant variables (P < .1) were entered into a stepwise logistic regression model for multivariate analysis. RESULTS: Data for 3373 cases were submitted by 165 centers, with 158 early complications reported in 151 patients (4.5%). We identified 13 significant variables in the univariate analysis. Multivariate analysis revealed that 8 (62%) of them were independent predictors of early complications. Female sex (odds ratio and 95% confidence interval 1.6; 1.13-2.27), hypertrophic cardiomyopathy (2.2; 1.08-4.5), valvular heart disease (2.53; 1.28-5.05), deep sedation during the procedure (1.53; 1.09-2.12), and complex fractionated atrial electrocardiogram ablation (1.88; 1.23-2.87) increased early complications. Preprocedural transesophageal echocardiography (0.63; 0.43-0.92), irrigated-tip catheter use (0.46; 0.3-0.69), and periprocedural novel oral anticoagulant use (0.55; 0.32-0.97) decreased them. CONCLUSION: The risk of early complications is increased by female sex, hypertrophic cardiomyopathy, valvular heart disease, deep sedation, and complex fractionated atrial electrocardiogram ablation. It is decreased by preprocedural transesophageal echocardiography, periprocedural novel oral anticoagulant, and irrigated-tip catheter use.
Authors: Fredrik Holmqvist; Milos Kesek; Anders Englund; Carina Blomström-Lundqvist; Lars O Karlsson; Göran Kennebäck; Dritan Poçi; Romeo Samo-Ayou; Runa Sigurjónsdóttir; Michael Ringborn; Csaba Herczku; Jonas Carlson; Espen Fengsrud; Fariborz Tabrizi; Niklas Höglund; Stefan Lönnerholm; Ole Kongstad; Anders Jönsson; Per Insulander Journal: Eur Heart J Date: 2019-03-07 Impact factor: 29.983