Incidence, Mechanism, and Management of Atrial Ablation Procedure Complications: A Literature Review

The number of atrial catheter ablation procedures has significantly increased in recent years, becoming a first-line treatment modality for various supraventricular tachycardias due to their safety and efficacy. Complications, ranging from mild to life-threatening, can arise during different stages of the procedure, including vascular access complications (eg, hematoma or vascular fistula formation, retroperitoneal bleeding, etc.), thromboembolic complications (eg, stroke, transient ischemic attack, air embolism, etc.), mechanical complications (eg, cardiac perforation and tamponade), as well as pulmonary vein stenosis, atrio-esophageal fistulas, phrenic nerve injury, and gastroparesis. Atrial fibrillation ablation procedures, in particular, carry a higher complication rate due to their complexity. This review discusses the incidence, mechanisms, diagnosis, management, and prevention of these complications. Key strategies to reduce risks include optimized anticoagulation protocols, the use of intracardiac echocardiography, reduced energy delivery, and esophageal temperature monitoring, among others. Timely detection and intervention, especially in the case of life-threatening complications, is crucial. Pulsed-field ablation, a novel technique using nonthermal electrical energy, offers a promising and precise alternative to conventional thermal ablation with a favorable safety profile. However, further research is needed to fully understand its complications and refine management strategies.