Overview
Catheter ablation of AF is one of the most complex interventional electrophysiological procedures. AF ablation by its nature involves catheter manipulation and ablation in the delicate thin-walled atria, which are in close proximity to other important organs and structures that can be impacted through collateral damage. It is therefore not surprising that AF ablation is associated with a significant risk of complications, some of which might result in life-long disability and/or death. In this section of the document we will review the complications associated with catheter ablation procedures performed to treat AF. The complications are defined and their mechanisms explored. Emphasis is placed on both those complications that occur most frequently as well as those very infrequent complications that have the potential to result in the greatest disability and/or death. Means of avoiding complications are described and recommendations are made regarding management should the complications occur.
It is noteworthy that the publications from which these data are derived come from high-volume centers where one would expect the incidence of complications to be lower than in lower-volume centers. As the practice of AF ablation grows with an increasing number of low-volume centers performing these procedures, it is likely that the true complication rate of AF ablation will be higher than described here. Furthermore, other data such as those derived from the two worldwide surveys of catheter ablation of AF were provided voluntarily and, again, are therefore likely to underestimate the true complication rate.806,920 It is notable that a recent paper reported on the trends in hospital complication rates associated with AF ablation between 2000 and 2010 based on the Nationwide Inpatient Sample involving 93,801 procedures.921 The overall incidence of complications was 6.29%—increasing from 5.3% in 2000 to 7.5% in 2010. The in-hospital mortality was 0.46%. Not surprisingly, lower operator and hospital procedure volume was an important predictor of complications. These data are a stark reminder that our efforts to eliminate complications associated with AF ablation are incomplete and there is more work to do.
As our experience with AF ablation continues to grow, new complications are recognized and are reviewed here. These include stiff LA syndrome, cough, pulmonary injury, gastric hypomotility, and sinus tachycardia. Once again, the writing group strongly recommends that standardized reporting of complications be part of all published reports on AF ablation. In this document, we have provided definitions of the most important complications associated with AF ablation (Table 8). We hope these definitions and reporting standards can be incorporated in the design of future clinical trials of AF ablation. Shown in Table 9 is an overview of the incidence, prevention, diagnosis, and management of selected complications, and Table 5 presents signs and symptoms associated with various complications early and late postablation.