Radiofrequency catheter ablation
(RFA) has evolved as an effective treatment modality in patients with atrial
fibrillation (AF). Despite advances in RFA techniques and technology, and attempts
to increase awareness and optimize management of procedural complications, there
has not been a substantial decrease in complication rates over the last decade.
A recent survey conducted by Cappato et
al that
included 20,000 atrial fibrillation ablation procedures performed between 2003
and 2006 identified major complications in 4.5% of procedures; this is not
significantly decreased from the complication rate of 4.0% reported on a survey
conducted by the same group between 1995 and 2002. This lack
of significant improvement is at least partly due to the higher proportion of
older patients and those with significant comorbidities such as cardiomyopathy. Overall,
complication rates associated with RFA of AF have been cited in the range of
3.5 – 5%. The distribution
of complications has also remained similar over the last decade, with the
majority consisting of cardiac tamponade, vascular complications, and
thromboembolic phenomena. In
this report, the incidences and outcomes of major complications associated with
catheter ablation of AF as well as potential strategies for their management
will be reviewed.
Credits: Timir Baman, MD; Rakesh Latchamsetty, MD; Hakan Oral, MD