[Complications of radiofrequency ablation: A French experience. Le Groupe de Rythmologie de la Société Francaise de Cardiologie]

Abstract

The multiplication of the indication of radiofrequency for curative or palliative treatment of cardiac arrhythmias motivated the Rhythmology Working Group to set up a register of the complications related to this technique. Five thousand six hundred and eighty nine cases from 19 French centres were recensed up to March 1996. There were 2765 ablations of a Bundle of Kent, 1579 ablations of slow pathways, 621 ablations of atrial flutter, 25 ablations of atrial tachycardia, 200 ablations of ventricular tachycardia and 499 ablations of the Bundle of His. Eighty five complications (1.5%), two of which were lethal (0.04%), were reported. The complications of catheterization (27% of all complications) were pneumothorax (n = 6), arterial thrombosis (n = 3), venous thrombosis with and without pulmonary embolism (n = 8), haematoma (n = 2), femoral pseudoaneurysm (n = 1), arteriovenous fistula (n = 1), infection (n = 2), valvular disease with mitral or aortic regurgitation (n = 3). Other complications were specific to the ablation itself:skin burns at the site of the patch (n = 2), ventricular fibrillation (n = 3), coronary events (n = 2), vascular events (n = 2), tamponade (n = 12), one of which was lethal, and transient or permanent complete atrioventricular block (n = 32) complicating ablation of antero and posteroseptal accessory pathways, atrial flutter and slow intranodal reentry pathways (n = 25). One lethal cerebral haemorrhage occurred the day after an ablation procedure. It was not possible to identify a predictive factor in these complications apart from the operator's experience. There were 1.4% of complications in Kent bundle ablations, 1.9% in ablation of slow pathway, 0.6% in atrial flutter and tachycardia, 1.5% for ventricular tachycardia and 1.9% for Bundle of His. The authors concluded that the prevalence of complications, though small with minimal risk of mortality (0.04%), should incite physicians to reserve this technique for symptomatic patients or those with potentially lethal arrhythmias.