Complications in AF ablation

BALTIMORE, MARYLAND. Although the risk of dying during or after a RF ablation for atrial fibrillation is infinitesimally small, the risk of major complications is not negligible. A recent worldwide survey found a major complications rate of 6%, while a just published Italian study found a rate of 3.9%. A study at the Cleveland Clinic (400 patients) found a moderate-to-severe stenosis rate of 0.25%, a stroke/TIA rate of 0.8%, and the risk of tamponade at 0.5% for a total major event rate of 1.6%. In contrast, an Austrian study involving only 75 patients found a serious adverse event rate of 12%.

Electrophysiologists at Johns Hopkins Hospital in Baltimore report on their complication rate in a series of 517 patients treated for atrial fibrillation by RF ablation during the period 2001 to 2007. Up until January 2003 the segmental (Haissaguerre) procedure was used. It was replaced by the circumferential (Pappone, CARTO) method and in March 2005 the CartoMerge system (combining CARTO and CT scan or MRI images) was added. The 517 patients underwent a total of 641 procedures (24% repeat rate). Overall success rate was not reported, but an earlier report from Johns Hopkins involving 200 patients gave the complete success rate as 28% after one procedure and 41% after multiple procedures. The most common major complications are listed below:

  • Stroke -7 incidents - 1.1 %
  • Tamponade - 8 incidents - 1.2 %
  • Vascular injury - 11 incidents - 1.7 %
  • Pulmonary vein occlusion - 1 incident - 0.2 %
  • Hemothorax - 2 incidents - 0.3 %
  • Heart block - 1 incident - 0.2 %
  • Acute lung injury -1 incident - 0.2 %
  • Mitral valve injury -1 incident - 0.1 %

The researchers found an overall major complication rate of 5.0%. The rate was higher (6.0%) for patients over the age of 70 years and for women (7.8%). They conclude that complication rates for AF ablation remain significant.

Spragg, DD, et al. Complications of catheter ablation for atrial fibrillation: incidence and predictors. Journal of Cardiovascular Electrophysiology, Vol. 19, June 2008, pp. 627-31