COMPETENCY IN PATIENT CARE AND PROCEDURAL SKILLS: Procedural complications of catheter-based ablation for AF have decreased in recent years
Original InvestigationProcedure-Related Complications of Catheter Ablation for Atrial Fibrillation
Central Illustration
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.
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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