Original Investigation
Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation

https://doi.org/10.1016/j.jacc.2023.03.418Get rights and content

Abstract

Background

Catheter ablation of atrial fibrillation (AF) is a commonly performed procedure. However, it is associated with potentially significant complications. Reported procedure–related complication rates are highly variable, depending in part on study design.

Objectives

The purpose of this systematic review and pooled analysis was to determine the rate of procedure-related complications associated with catheter ablation of AF using data from randomized control trials and to assess temporal trends.

Methods

MEDLINE and EMBASE databases were searched from January 2013 to September 2022 for randomized control trials that included patients undergoing a first ablation procedure of AF using either radiofrequency or cryoballoon (PROSPERO, CRD42022370273).

Results

A total of 1,468 references were retrieved, of which 89 studies met inclusion criteria. A total of 15,701 patients were included in the current analysis. Overall and severe procedure-related complication rates were 4.51% (95% CI: 3.76%-5.32%) and 2.44% (95% CI: 1.98%-2.93%), respectively. Vascular complications were the most frequent type of complication (1.31%). The next most common complications were pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%). The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.77% vs 5.31%; P = 0.043). The pooled mortality rate was stable over the 2 time periods (0.06% vs 0.05%; P = 0.892). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation.

Conclusions

Procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade.

Section snippets

Data sources and search

The literature search was performed in PubMed/MEDLINE and EMBASE databases from January 1, 2013, to September 31, 2022, to identify RCTs describing complications of CA of AF. Independent searches were performed by 2 investigators (K.B. and N.H.) using the following Medical Subject Headings: “atrial fibrillation,” “ablation,” “catheter ablation,” “complication,” “adverse events,” “outcomes,” and “randomized.” This was supplemented by hand-searching bibliographies of retrieved papers as well as

Results

A total of 89 RCTs were included in the meta-analysis, comprising a total of 15,701 patients undergoing a first CA procedure for AF. The PRISMA flow diagram showing the number and reasons for exclusion of publications from the originally retrieved citations is outlined in Figure 1. A summary of the main characteristics of the included RCTs is presented in Table 1, with additional details provided in Supplemental Table 1. The studies consisted of 49 multicenter RCTs and 40 single-center RCTs,

Discussion

The present study, which included >15,000 patients from 89 RCTs, is the largest meta-analysis to date, to the best of our knowledge, of patients undergoing a first procedure of CA for AF. In this analysis, the rate of overall procedure-related complications was 4.5% with an incidence of severe complications of 2.4%. Moreover, a significant reduction (∼30%) was observed in the complication rate when the contemporary period of publication (2018-2022) was compared with the preceding period

Conclusions

Periprocedural complication rates and mortality associated with a first CA procedure for AF are low. A significant improvement in the safety profile of the procedure was observed over the last 5 years. Neither the type of energy used for ablation nor the creation of additional lesions on top of PVI significantly influenced the procedural complication rate.

COMPETENCY IN PATIENT CARE AND PROCEDURAL SKILLS: Procedural complications of catheter-based ablation for AF have decreased in recent years

Funding Support and Author Disclosures

Dr Benali has received grant support from the Group of Pacing and Cardiac Electrophysiology of the French Society of Cardiology. Dr Verma has received grant support, advisory board fees, and lecture fees from Bayer, Biosense Webster, and Medtronic; has received grant support from Biotronik, Bristol Myers Squibb, and Boehringer Ingelheim; has received consulting fees from Boston Scientific, MedLumics, and Thermedical; and has received lecture fees from Servier. Dr Andrade has received grant

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