PT  - JOURNAL ARTICLE
AU  - Chun, K.R. Julian
AU  - Perrotta, Laura
AU  - Bordignon, Stefano
AU  - Khalil, Jan
AU  - Dugo, Daniela
AU  - Konstantinou, Athanasios
AU  - Fürnkranz, Alexander
AU  - Schmidt, Boris
TI  - Complications in Catheter Ablation of Atrial Fibrillation in 3,000 Consecutive Procedures
AID  - 10.1016/j.jacep.2016.07.002
DP  - 2017 Feb 01
TA  - JACC: Clinical Electrophysiology
PG  - 154--161
VI  - 3
IP  - 2
4099  - http://electrophysiology.onlinejacc.org/content/3/2/154.short
4100  - http://electrophysiology.onlinejacc.org/content/3/2/154.full
AB  - Objectives The aim of this study was to identify predictors of cardiac tamponade (CT) during atrial fibrillation (AF) ablation using different technologies and strategies.Background The major cause of death during catheter ablation of AF is related to CT. The risk for CT may be linked to different procedural steps (transseptal puncture, catheter manipulation during left atrial and pulmonary vein mapping and ablation).Methods All AF ablation procedures undertaken from May 2010 to July 2015 at a single center were included. Two ablation groups were defined: group A, radiofrequency current, and group B, balloon. Group A was divided into groups A1 (pulmonary vein isolation [PVI] only) and A2 (PVI plus additional ablation). In group A, 2 transseptal punctures were performed, followed by wide-area circumferential point-by-point PVI (group A1) within a 3-dimensional left atrial map and complex fractionated atrial electrograms and/or linear lesions (group A2). In group B, 1 transseptal puncture by balloon-based PVI (cryoballoon, laser balloon). All episodes of CT were analyzed.Results In total, 3,000 AF ablation procedures were performed, 2,125 in group A (group A1, n = 1,559; group A2, n = 566) and 875 in group B (cryoballoon, n = 589; laser balloon, n = 286). The rate of CT was 1.1% (32 of 3,000) and was significantly lower in group B than in group A: 0.1% (1 of 875) versus 1.5% (31 of 2,125) (p = 0.001). The reduced CT risk remained if PVI only (group B vs. group A1) was compared: 0.8% (13 of 1,559) versus 0.1% (1 of 875) (p = 0.024). The greatest CT risk was seen in group A2: 3.2% (18 of 566). Radiofrequency current ablation beyond PVI was a predictor of CT.Conclusions The risk for CT in patients undergoing AF ablation at a single high-volume center was decreased with the use of balloon catheters. Extensive radiofrequency current ablation beyond PVI leads to an increased perforation risk.