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Outcomes after cardiac perforation during radiofrequency ablation of the atrium
T Jared Bunch1, Samuel J Asirvatham, Paul A Friedman
1Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Cardiac perforation during radiofrequency ablation is uncommon but serious. Most left atrial perforations during ablation for atrial fibrillation (AF) are managed conservatively, with most patients achieving long-term AF control.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Cardiac perforation during catheter procedures is a rare but potentially fatal complication.
- This study focuses on cardiac perforation during catheter-based radiofrequency ablation in the left atrium.
Purpose of the Study:
- To analyze the incidence and outcomes of cardiac perforation during radiofrequency ablation procedures in the left atrium.
- To evaluate the management and long-term results of patients experiencing cardiac perforation during atrial fibrillation ablation.
Main Methods:
- Retrospective analysis of patients undergoing radiofrequency ablation for atrial fibrillation or tachycardia with periprocedural perforation.
- Inclusion criteria: patients with periprocedural perforation requiring pericardiocentesis.
Main Results:
- 15 out of 632 procedures (2.4%) resulted in perforation requiring pericardiocentesis.
- Left atrium was the most common perforation site (60.0%), followed by the right ventricle (33.3%).
- Intracardiac echocardiography identified effusions early; 86.7% of patients developed significant hypotension, stabilized post-pericardiocentesis.
Conclusions:
- Cardiac perforation during left atrial ablation is infrequent, with most perforations occurring in the left atrium.
- Surgical intervention is rarely required for left atrial perforations.
- A majority of patients with completed ablations achieve long-term atrial fibrillation elimination or control.
Background:
Perforation during catheter procedures in either the atrium or ventricle is relatively uncommon, but potentially fatal if tamponade ensues. This study analyzes the occurrence and outcomes of cardiac perforation during catheter-based radiofrequency ablation procedures in the left atrium.
Methods:
All patients with a periprocedure perforation who have undergone radiofrequency ablation for atrial fibrillation (AF) or tachycardia were included.
Results:
Of 632 procedures performed from January 1999 to October 2004, 15 (2.4%) were complicated by perforation requiring pericardiocentesis. The perforation site was left atrium in 9 (60.0%), right atrium in 1 (6.7%), and right ventricle in 5 (33.3%). Intracardiac echocardiography was used in 13 (86.7%) and revealed an effusion before overt instability in 11 (73.3%). Thirteen (86.7%) patients developed a blood pressure <60 mmHg. The pressure stabilized in all patients after pericardiocentesis (hypotension to intervention: 10.1 +/- 5.1 minutes). The total blood volume removed was 848 +/- 880 mL (left atrium/right atrium: 1,074 +/- 1,002 vs right ventricle: 396 +/- 266, P = 0.168). Two patients required surgery to close left atrium dome perforations. The ablation was completed in 7 (46.7%) patients. Ten (66.7%) later developed early reoccurrence of AF. All patients were neurologically intact at hospital discharge. During a 1.5 +/- 1.1 year follow-up, AF was eliminated (n = 4) or controlled (n = 1) in 5 (71.4%) patients with complete procedures, and 2 (20.0%) patients underwent successful repeat ablation.
Conclusion:
The incidence of perforation during ablation of the left atrium is low. Most perforations occur in the left atrium; however, few require surgical closure. Although less than with uncomplicated procedures, the majority of patients with complete ablations achieve long-term elimination of AF.
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