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.
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.
Authors: Zak Loring; DaJuanicia N Holmes; Roland A Matsouaka; Anne B Curtis; John D Day; Nihar Desai; Kenneth A Ellenbogen; Gregory K Feld; Gregg C Fonarow; David S Frankel; Jodie L Hurwitz; Bradley P Knight; Jose A Joglar; Andrea M Russo; Mandeep S Sidhu; Mintu P Turakhia; William R Lewis; Jonathan P Piccini Journal: Circ Arrhythm Electrophysiol Date: 2020-07-23
Authors: Thomas Fink; Andreas Metzner; Stephan Willems; Lars Eckardt; Hüseyin Ince; Johannes Brachmann; Stefan G Spitzer; Thomas Deneke; Claus Schmitt; Matthias Hochadel; Jochen Senges; Andreas Rillig Journal: Clin Res Cardiol Date: 2019-04-05 Impact factor: 5.460
Authors: Julian Chun; Tilman Maurer; Andreas Rillig; Stefano Bordignon; Leon Iden; Sonia Busch; Daniel Steven; Roland R Tilz; Dong-In Shin; Heidi Estner; Felix Bourier; David Duncker; Philipp Sommer; Nils-Christian Ewertsen; Henning Jansen; Victoria Johnson; Livio Bertagnolli; Till Althoff; Andreas Metzner Journal: Herzschrittmacherther Elektrophysiol Date: 2021-11-04
Authors: Ellen Hoffmann; Florian Straube; Karl Wegscheider; Malte Kuniss; Dietrich Andresen; Li-Qun Wu; Jürgen Tebbenjohanns; Georg Noelker; Roland Richard Tilz; Julian Kyoung Ryul Chun; Andreas Franke; Christoph Stellbrink; Arcadi Garcia-Alberola; Uwe Dorwarth; Andreas Metzner; Taoufik Ouarrak; Johannes Brachmann; Karl-Heinz Kuck; Jochen Senges Journal: Europace Date: 2019-09-01 Impact factor: 5.214