Prevalence and Causes of Fatal Outcome in Catheter Ablation of Atrial Fibrillation

Riccardo Cappato, Hugh Calkins, Shih Ann Chen, Wyn Davies, Yoshito Iesaka, Jonathan Kalman, You Ho Kim, George Klein, Andrea Natale, Douglas Packer, Allan Skanes

Research output: Contribution to journalArticle

Abstract

Objectives: The purpose of this study was to provide a systematic multicenter survey on the incidence and causes of death occurring in the setting of or as a consequence of catheter ablation (CA) of atrial fibrillation (AF). Background: CA of AF is considered to be generally safe. However, serious complications, including death, have been reported. Methods: Using a retrospective case series, data relevant to the incidence and cause of intra- and post-procedural death occurring in patients undergoing CA of AF between 1995 and 2006 were collected from 162 of 546 identified centers worldwide. Results: Thirty-two deaths (0.98 per 1,000 patients) were reported during 45,115 procedures in 32,569 patients. Causes of deaths included tamponade in 8 patients (1 later than 30 days), stroke in 5 patients (2 later than 30 days), atrioesophageal fistula in 5 patients, and massive pneumonia in 2 patients. Myocardial infarction, intractable torsades de pointes, septicemia, sudden respiratory arrest, extrapericardial pulmonary vein (PV) perforation, occlusion of both lateral PVs, hemothorax, and anaphylaxis were reported to be responsible for 1 death each, while asphyxia from tracheal compression secondary to subclavian hematoma, intracranial bleeding, acute respiratory distress syndrome, and esophageal perforation from an intraoperative transesophageal echocardiographic probe were causes of 1 late death each. Conclusions: Death is a complication of CA of AF, occurring in 1 of 1,000 patients. Knowledge of possible precipitating causes is key to operators and needs to be considered during decision making with patients.

Original languageEnglish (US)
Pages (from-to)1798-1803
Number of pages6
JournalJournal of the American College of Cardiology
Volume53
Issue number19
DOIs
StatePublished - May 12 2009

Keywords

  • atrial fibrillation
  • catheter ablation
  • pulmonary vein
  • radiofrequency
  • supraventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Cappato, R., Calkins, H., Chen, S. A., Davies, W., Iesaka, Y., Kalman, J., Kim, Y. H., Klein, G., Natale, A., Packer, D., & Skanes, A. (2009). Prevalence and Causes of Fatal Outcome in Catheter Ablation of Atrial Fibrillation. Journal of the American College of Cardiology, 53(19), 1798-1803. https://doi.org/10.1016/j.jacc.2009.02.022