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

被引:461
作者
Cappato, Riccardo [1 ]
Calkins, Hugh [2 ]
Chen, Shih-Ann [3 ]
Davies, Wyn [4 ]
Iesaka, Yoshito [5 ]
Kalman, Jonathan [6 ]
Kim, You-Ho [7 ]
Klein, George [8 ]
Natale, Andrea [9 ]
Packer, Douglas [10 ]
Skanes, Allan [8 ]
机构
[1] IRCCS Policlin San Donato, Arrhythmias & Electrophysiol Ctr, Milan, Italy
[2] Johns Hopkins Univ, Sch Med, Baltimore, MD USA
[3] Vet Gen Hosp, Taipei, Taiwan
[4] St Marys Hosp, London, England
[5] Tsuchiura Kyodo Gen Hosp, Ctr Cardiovasc, Tsuchiura, Ibaraki, Japan
[6] Royal Melbourne Hosp, Parkville, Vic 3050, Australia
[7] Asan Med Ctr, Dept Cardiol, Seoul, South Korea
[8] Univ Western Ontario, Univ Hosp, Dept Cardiol, London, ON N6A 5A5, Canada
[9] St Davids Med Ctr, Texas Arrhythmia Inst, Austin, TX USA
[10] St Mary Hosp, Mayo Fdn, Div Cardiol, Rochester, MN USA
关键词
atrial fibrillation; catheter ablation; supraventricular; radiofrequency; pulmonary vein; RADIOFREQUENCY ABLATION; ESOPHAGEAL FISTULA; COMPLICATION;
D O I
10.1016/j.jacc.2009.02.022
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. (J Am Coll Cardiol 2009; 53: 1798-803) (C) 2009 by the American College of Cardiology Foundation
引用
收藏
页码:1798 / 1803
页数:6
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