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CLINICAL RESEARCH: HEART RHYTHM DISORDER

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

Riccardo Cappato, MD^_*,_*, Hugh Calkins, MD, Shih-Ann Chen, MD, Wyn Davies, MD, Yoshito Iesaka, MD^||, Jonathan Kalman, MD^¶, You-Ho Kim, MD^#, George Klein, MD^_**, Andrea Natale, MD, Douglas Packer, MD and Allan Skanes, MD^_**

^_* Arrhythmias and Electrophysiology Center, I.R.C.C.S. Policlinico San Donato, Milan, Italy
Johns Hopkins University School of Medicine, Baltimore, Maryland
Veterans General Hospital, Taipei, Taiwan
St. Mary's Hospital, London, United Kingdom
^|| Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
^¶ Royal Melbourne Hospital, Parkville, Victoria, Australia
^# Cardiology Department, Asan Medical Center, Seoul, South Korea
^_** Department of Cardiology, University Hospital, London, Ontario, Canada
Texas Arrhythmia Institute, St. David's Medical Center, Austin, Texas
Division of Cardiology, Mayo Foundation–St. Mary Hospital, Rochester, Minnesota

Manuscript received November 12, 2008; revised manuscript received January 6, 2009, accepted February 13, 2009.

^_* Reprint requests and correspondence: Dr. Riccardo Cappato, Arrhythmia and Electrophysiology Center, Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097 Milan, Italy (Email: rcappato{at}libero.it).

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.

Key Words: atrial fibrillation • catheter ablation • supraventricular • radiofrequency • pulmonary vein

Abbreviations and Acronyms   AF = atrial fibrillation   CA = catheter ablation   EP = electrophysiology   PV = pulmonary vein   RF = radiofrequency   SV = supraventricular   TEE = transesophageal echocardiographic

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