Author + information
- Received August 29, 2018
- Revision received November 19, 2018
- Accepted November 21, 2018
- Published online January 30, 2019.
- Karim Abdur Rehman, MDa,
- Oussama M. Wazni, MDa,
- Amr F. Barakat, MDa,
- Walid I. Saliba, MDa,
- Shailee Shah, MDb,
- Khaldoun G. Tarakji, MDa,
- John Rickard, MDa,
- Mohamed Bassiouny, MDa,
- Bryan Baranowski, MDa,
- Patrick J. Tchou, MDa,
- Mandeep Bhargava, MDa,
- Thomas J. Dresing, MDa,
- Thomas D. Callahan, MDa,
- Daniel J. Cantillon, MDa,
- Mina Chung, MDa,
- Mohamed Kanj, MDa,
- Samuel Irefin, MDa,
- Bruce Lindsay, MDa and
- Ayman A. Hussein, MDa,∗ ()
- aSydell and Arnold Miller Family Heart and Vascular Institute, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio
- bDepartment of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Ayman Hussein, Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, J2-2, Cleveland, Ohio 44195.
Objectives This study sought to assess the incidence and outcomes of life-threatening complications from atrial fibrillation ablations in a high volume center.
Background With increasing rates of atrial fibrillation ablation procedures, an increase in life-threatening procedure-related complications has been reported despite improvements in technology and ablation strategies.
Methods Between 2000 and 2015, 10,378 patients underwent atrial fibrillation ablation at our institution and were enrolled in a prospectively maintained data registry. We identified all patients who had life-threatening cardiac, neurological, respiratory, or vascular complications to the ablation resulting in death or requiring emergent intervention.
Results Major life-threatening complications occurred in 100 patients (0.9%). The most common was pericardial effusion requiring pericardiocentesis (0.5%), with 7 (0.07%) requiring emergent surgical repair for cardiac perforation. Stroke occurred in 27 patients (0.3%) with a vast majority having an ischemic stroke (93%) followed by hemorrhagic (3.5%) and ischemic stroke with hemorrhagic conversion (3.5%). The yearly incidence of stroke decreased from an average of 1.1% per year in the first tertile (2000 to 2004) to 0.2% per year in the last 2 tertiles (2005 to 2015). Permanent neurological deficits occurred in 23 patients. Vascular complications causing hemorrhagic shock occurred in 7 patients (0.06%), 5 of whom required urgent surgical intervention. Acute coronary syndrome requiring urgent percutaneous coronary revascularization occurred in 2 patients whereas 1 developed a right coronary artery air embolus. No procedural death or atrio-esophageal fistulae occurred.
Conclusions In a large quaternary care center, the incidence of life-threatening complications is low. Experienced operators, high volume, continuous quality improvement initiatives, and efficient back-up support have allowed exemplary safety profiles and 0 procedure-related deaths over 16 years.
Drs. Wazni and Cantillon have received consulting honoraria from Biosense Webster. Dr. Saliba is an Advisory Board member of Boston Scientific. Dr. Tarakji is an Advisory Board member of Medtronic and AliveCor; and has received consulting honoraria from Medtronic and AliveCor. Dr. Rickard is a consultant for Abbott and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received August 29, 2018.
- Revision received November 19, 2018.
- Accepted November 21, 2018.
- 2019 American College of Cardiology Foundation
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