Daniel Mol1,2, Saskia Houterman3, Jippe C Balt4, Rohit E Bhagwandien5, Yuri Blaauw6, Peter-Paul H Delnoy7, Vincent J van Driel8, Antoine H Driessen2, Richard J Folkeringa9, Rutger J Hassink10, Bart Hooft van Huysduynen11, Justin G Luermans12, Alexandre J Ouss13, Yorick J Stevenhagen14, Dennis van Veghel3, Sjoerd W Westra15, Jonas S de Jong1, Joris R de Groot2. 1. Department of Cardiology, OLVG, Oosterpark 9 1091 AC Amsterdam, The Netherlands. 2. Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands. 3. Netherlands Heart Registration, Eindhoven, The Netherlands. 4. Department of Cardiology, St. Antonius, Nieuwegein, The Netherlands. 5. Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands. 6. Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands. 7. Department of Cardiology, Isala, Zwolle, The Netherlands. 8. Department of Cardiology, Haga Hospital, Den Haag, The Netherlands. 9. Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. 10. Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands. 11. Department of Cardiology, Amphia, Breda, The Netherlands. 12. Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands. 13. Department of Cardiology and Cardiac Surgery, Catharina Hospital, Eindhoven, The Netherlands. 14. Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands. 15. Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Abstract
AIMS: Pulmonary vein isolation (PVI) has become a cornerstone of the invasive treatment of atrial fibrillation. Severe complications are reported in 1-3% of patients. This study aims to compare complications and follow-up outcome of PVI in patients with atrial fibrillation. METHODS AND RESULTS: The data were extracted from the Netherlands Heart Registration. Procedural and follow-up outcomes in patients treated with conventional radiofrequency (C-RF), multielectrode phased RF (Ph-RF), or cryoballoon (CB) ablation from 2012 to 2017 were compared. Subgroup analysis was performed to identify variables associated with complications and repeat ablations. In total, 13 823 patients (69% male) were included. The reported complication incidence was 3.6%. Patients treated with C-RF developed more cardiac tamponades (C-RF 0.8% vs. Ph-RF 0.3% vs. CB 0.3%, P ≤ 0.001) and vascular complications (C-RF 1.7% vs. Ph-RF 1.2% vs. CB 1.3%, P ≤ 0.001). Ph-RF was associated with fewer bleeding complications (C-RF: 1.0% vs. Ph-RF: 0.4% vs. CB: 0.7%, P = 0.020). Phrenic nerve palsy mainly occurred in patients treated with CB (C-RF: 0.1% vs. Ph-RF: 0.2% vs. CB: 1.5%, P ≤ 0.001). In total, 18.4% of patients were referred for repeat ablation within 1 year. Female sex, age, and CHA2DS2-VASc were independent risk factors for cardiac tamponade and bleeding complications, with an adjusted OR for female patients of 2.97 (95% CI 1.98-4.45) and 2.02 (95% CI 1.03-4.00) respectively. CONCLUSION: The reported complication rate during PVI was low. Patients treated with C-RF ablation were more likely to develop cardiac tamponades and vascular complications. Female sex was associated with more cardiac tamponade and bleeding complications. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Pulmonary vein isolation (PVI) has become a cornerstone of the invasive treatment of atrial fibrillation. Severe complications are reported in 1-3% of patients. This study aims to compare complications and follow-up outcome of PVI in patients with atrial fibrillation. METHODS AND RESULTS: The data were extracted from the Netherlands Heart Registration. Procedural and follow-up outcomes in patients treated with conventional radiofrequency (C-RF), multielectrode phased RF (Ph-RF), or cryoballoon (CB) ablation from 2012 to 2017 were compared. Subgroup analysis was performed to identify variables associated with complications and repeat ablations. In total, 13 823 patients (69% male) were included. The reported complication incidence was 3.6%. Patients treated with C-RF developed more cardiac tamponades (C-RF 0.8% vs. Ph-RF 0.3% vs. CB 0.3%, P ≤ 0.001) and vascular complications (C-RF 1.7% vs. Ph-RF 1.2% vs. CB 1.3%, P ≤ 0.001). Ph-RF was associated with fewer bleeding complications (C-RF: 1.0% vs. Ph-RF: 0.4% vs. CB: 0.7%, P = 0.020). Phrenic nerve palsy mainly occurred in patients treated with CB (C-RF: 0.1% vs. Ph-RF: 0.2% vs. CB: 1.5%, P ≤ 0.001). In total, 18.4% of patients were referred for repeat ablation within 1 year. Female sex, age, and CHA2DS2-VASc were independent risk factors for cardiac tamponade and bleeding complications, with an adjusted OR for female patients of 2.97 (95% CI 1.98-4.45) and 2.02 (95% CI 1.03-4.00) respectively. CONCLUSION: The reported complication rate during PVI was low. Patients treated with C-RF ablation were more likely to develop cardiac tamponades and vascular complications. Female sex was associated with more cardiac tamponade and bleeding complications. Published on behalf of the European Society of Cardiology. All rights reserved.
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Authors: Daniel Mol; Lisanne Renskers; Jippe C Balt; Rohit E Bhagwandien; Yuri Blaauw; Vincent J H M van Driel; Antoine H G Driessen; Arif Elvan; Richard Folkeringa; Rutger J Hassink; Bart Hooft van Huysduynen; Justin G L M Luermans; Jeroen Y Stevenhagen; Pepijn H van der Voort; Sjoerd W Westra; Joris R de Groot; Jonas S S G de Jong Journal: J Cardiovasc Electrophysiol Date: 2022-01-28 Impact factor: 2.942