OBJECTIVES: This study sought to assess the incidence and outcomes of life-threatening complications from atrial fibrillation ablations in a high volume center. BACKGROUND: With increasing rates of atrial fibrillation ablation procedures, an increase in life-threatening procedure-related complications has been reported despite improvements in technology and ablation strategies. METHODS: Between 2000 and 2015, 10,378 patients underwent atrial fibrillation ablation at our institution and were enrolled in a prospectively maintained data registry. We identified all patients who had life-threatening cardiac, neurological, respiratory, or vascular complications to the ablation resulting in death or requiring emergent intervention. RESULTS: Major life-threatening complications occurred in 100 patients (0.9%). The most common was pericardial effusion requiring pericardiocentesis (0.5%), with 7 (0.07%) requiring emergent surgical repair for cardiac perforation. Stroke occurred in 27 patients (0.3%) with a vast majority having an ischemic stroke (93%) followed by hemorrhagic (3.5%) and ischemic stroke with hemorrhagic conversion (3.5%). The yearly incidence of stroke decreased from an average of 1.1% per year in the first tertile (2000 to 2004) to 0.2% per year in the last 2 tertiles (2005 to 2015). Permanent neurological deficits occurred in 23 patients. Vascular complications causing hemorrhagic shock occurred in 7 patients (0.06%), 5 of whom required urgent surgical intervention. Acute coronary syndrome requiring urgent percutaneous coronary revascularization occurred in 2 patients whereas 1 developed a right coronary artery air embolus. No procedural death or atrio-esophageal fistulae occurred. CONCLUSIONS: In a large quaternary care center, the incidence of life-threatening complications is low. Experienced operators, high volume, continuous quality improvement initiatives, and efficient back-up support have allowed exemplary safety profiles and 0 procedure-related deaths over 16 years.
OBJECTIVES: This study sought to assess the incidence and outcomes of life-threatening complications from atrial fibrillation ablations in a high volume center. BACKGROUND: With increasing rates of atrial fibrillation ablation procedures, an increase in life-threatening procedure-related complications has been reported despite improvements in technology and ablation strategies. METHODS: Between 2000 and 2015, 10,378 patients underwent atrial fibrillation ablation at our institution and were enrolled in a prospectively maintained data registry. We identified all patients who had life-threatening cardiac, neurological, respiratory, or vascular complications to the ablation resulting in death or requiring emergent intervention. RESULTS: Major life-threatening complications occurred in 100 patients (0.9%). The most common was pericardial effusion requiring pericardiocentesis (0.5%), with 7 (0.07%) requiring emergent surgical repair for cardiac perforation. Stroke occurred in 27 patients (0.3%) with a vast majority having an ischemic stroke (93%) followed by hemorrhagic (3.5%) and ischemic stroke with hemorrhagic conversion (3.5%). The yearly incidence of stroke decreased from an average of 1.1% per year in the first tertile (2000 to 2004) to 0.2% per year in the last 2 tertiles (2005 to 2015). Permanent neurological deficits occurred in 23 patients. Vascular complications causing hemorrhagic shock occurred in 7 patients (0.06%), 5 of whom required urgent surgical intervention. Acute coronary syndrome requiring urgent percutaneous coronary revascularization occurred in 2 patients whereas 1 developed a right coronary artery air embolus. No procedural death or atrio-esophageal fistulae occurred. CONCLUSIONS: In a large quaternary care center, the incidence of life-threatening complications is low. Experienced operators, high volume, continuous quality improvement initiatives, and efficient back-up support have allowed exemplary safety profiles and 0 procedure-related deaths over 16 years.
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: Sanket S Dhruva; Joseph S Ross; Joseph G Akar; Brittany Caldwell; Karla Childers; Wing Chow; Laura Ciaccio; Paul Coplan; Jun Dong; Hayley J Dykhoff; Stephen Johnston; Todd Kellogg; Cynthia Long; Peter A Noseworthy; Kurt Roberts; Anindita Saha; Andrew Yoo; Nilay D Shah Journal: NPJ Digit Med Date: 2020-04-20