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Multicenter Study
. 2024 Jul;10(7 Pt 1):1353-1364.
doi: 10.1016/j.jacep.2024.03.024. Epub 2024 May 29.

Severe Periprocedural Complications After Ablation for Atrial Fibrillation: An International Collaborative Individual Patient Data Registry

Jeanne du Fay de Lavallaz  1 , Patrick Badertscher  1 , Michael Ghannam  2 , Hakan Oral  2 , Krit Jongnarangsin  2 , Serge Boveda  3 , Marta Madeira  4 , Dhiraj Gupta  5 , Wern Yew Ding  5 , Rui Providencia  6 , Edward MacLean  6 , Michifumi Tokuda  7 , Kenichi Tokutake  7 , Tobias Reichlin  8 , Fengxiang Zhang  9 , Daniel Scherr  10 , Miruna A Popa  11 , Henry Huang  12 , Nikola Pavlović  13 , Graham Peigh  14 , Xiaorong Li  15 , Karapet Davtyan  16 , Ioanna Kosmidou  17 , Matteo Anselmino  18 , Sandeep Jain  19 , Fabien Squara  20 , Eyal Nof  21 , Mario Matta  18 , Pipin Kojodjojo  22 , Ziad Khoueiry  23 , Sven Knecht  1 , Philipp Krisai  1 , Christian Sticherling  1 , Michael Kühne  24
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Free article
Multicenter Study

Severe Periprocedural Complications After Ablation for Atrial Fibrillation: An International Collaborative Individual Patient Data Registry

Jeanne du Fay de Lavallaz et al. JACC Clin Electrophysiol. 2024 Jul.
Free article

Abstract

Background: Catheter ablation for atrial fibrillation (AF) including pulmonary vein isolation and possibly further substrate ablation is the most common electrophysiological procedure. Severe complications are uncommon, but their detailed assessment in a large worldwide cohort is lacking.

Objectives: The aim of this study was to determine the incidence of periprocedural severe complications and to provide a detailed characterization of the diagnostic evaluation and management of these complications in patients undergoing AF ablation.

Methods: Individual patient data were collected from 23 centers worldwide. Limited data were collected for all patients who underwent catheter ablation, and an expanded series of data points were collected for patients who experienced severe complications during periprocedural follow-up. Incidence, predictors, patient characteristics, management details, and overall outcomes of patients who experienced ablation-related complications were investigated.

Results: Data were collected from 23 participating centers at which 33,879 procedures were performed (median age 63 years, 30% women, 71% radiofrequency ablations). The incidence of severe complications (n = 271) was low (tamponade 6.8‰, stroke 0.97‰, cardiac arrest 0.41‰, esophageal fistula 0.21‰, and death 0.21‰). Age, female sex, a dilated left atrium, procedure duration, and the use of radiofrequency energy were independently associated with the composite endpoint of all severe complications. Among patients experiencing tamponade, 13% required cardiac surgery. Ninety-three percent of patients with complications were discharged directly home after a median length of stay of 5 days (Q1-Q3: 3-7 days).

Conclusions: This large worldwide collaborative study highlighted that tamponade, stroke, cardiac arrest, esophageal fistula, and death are rare after AF ablation. Older age, female sex, procedure duration, a dilated left atrium, and the use of radiofrequency energy were associated with severe complications in this multinational cohort. One in 8 patients with tamponade required cardiac surgery.

Keywords: atrial fibrillation; cardiac arrest; catheter ablation; complications; esophageal fistula; incidence; predictors; pulmonary vein isolation; stroke; tamponade.

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Conflict of interest statement

Funding Support and Author Disclosures This project was funded by the University Hospital of Basel, the Swiss Heart Foundation, and Freiwillige Akademische Gesellschaft Basel. Dr du Fay de Lavallaz has received grants from the Swiss Heart Foundation and Freiwillige Akademische Gesellschaft Basel, both for the funding of this project. Dr Kühne has received grants from the Swiss National Science Foundation (grants 33CS30_148474, 33CS30_177520, 32473B_176178, and 32003B_197524), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel, the University of Basel, Bayer, Pfizer, Boston Scientific, Bristol Myers Squibb, and Biotronik; and has received grants and personal fees from Daiichi-Sankyo. Dr Krisai has received speaker fees from Bristol Myers Squibb. Dr Boveda is consultant for Medtronic, Boston Scientific, MicroPort, and Zoll. Dr Anselmino is consultant for Biosense Webster and Boston Scientific; is a clinical proctor for Medtronic; and has received educational grants from Abbott. Dr Kosmidou is an advisory board member for Sanofi and Pfizer. Dr Davtyan serves as a proctor for Medtronic and Abbott. Dr Huang has received research grants and a speaking honorarium from Biosense Webster. Dr Pavlović has received proctoring fees from Abbott, Biosense Webster, and Medtronic; and has received research grants from Medtronic. Dr Gupta is a speaker for Boehringer Ingelheim, Biosense Webster, and Boston Scientific; is a proctor for Abbott; and has received research grants from Medtronic, Biosense Webster, and Boston Scientific. Dr Providencia has received a research grant from Biosense Webster. Dr Tokuda has received a speaker honorarium and consulting fees from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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