Iatrogenic aortic dissection during catheter ablation for ventricular arrhythmia

Attempted catheter manipulation through the retrograde aortic approach carries a risk of aortic dissection (AD) during catheter ablation.

This study aimed to determine the incidence, management, and outcomes of iatrogenic AD associated with ablation of ventricular arrhythmia (VA).

All patients who sustained iatrogenic AD during retrograde aortic VA ablation at 6 centers between January 1, 2011, and September 30, 2023, were prospectively identified.

Of 5925 patients who underwent ablation procedures during the study period, iatrogenic AD developed in 18 (0.3%; 8 type A AD, 10 type B AD) during the procedure. The mean age was 65.4 ± 5.3 years, and 5 patients (27.8%) were female. Considerable catheter resistance was reported in all cases. Presenting symptoms included sudden-onset severe chest pain (n = 13 [72.2%]), back pain (n = 9 [50%]), abdominal pain (n = 3 [16.7%]), and syncope (n = 3 [16.7%]). Of the type A AD patients, 3 (37.5%) with antegrade dissection underwent surgical repair, and 2 (25%) with retrograde dissection were successfully managed conservatively. Three (30%) of the type B AD patients underwent endovascular intervention and 7 (70%) were managed medically. Three patients (16.7%) died; all had type A AD and died of severe hemodynamic compromise. None of the 15 survivors had aorta-related complications during a mean follow-up of 72.7 ± 46.8 months.

Iatrogenic AD is a rare but potentially lethal complication of retrograde aortic VA ablation. Comprehensive measures should be taken to reduce the risk of iatrogenic AD.