Iatrogenic aortic dissection during catheter ablation for ventricular arrhythmia

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Catheter ablation for ventricular arrhythmia (VA) via the retrograde aortic approach carries an inherent risk of iatrogenic aortic dissection (AD).
• Understanding the incidence and outcomes of AD is crucial for patient safety during these procedures.

Purpose of the Study:

• To determine the incidence, management strategies, and clinical outcomes of iatrogenic AD.
• To evaluate the complications and mortality associated with AD during VA ablation.

Main Methods:

• A prospective study identified patients who developed iatrogenic AD during retrograde aortic VA ablation across six centers.
• Data collection spanned from January 1, 2011, to September 30, 2023, encompassing patient demographics, procedural details, and clinical course.

Main Results:

• Iatrogenic AD occurred in 18 (0.3%) of 5925 patients, with 8 type A and 10 type B dissections.
• Common symptoms included chest and back pain. Management varied by AD type, with surgical repair for some type A and endovascular or medical management for type B.
• Mortality was 16.7% (3 patients), all with type A AD and severe hemodynamic compromise. Survivors showed no long-term aorta-related complications.

Conclusions:

• Iatrogenic AD is a rare but potentially fatal complication of retrograde aortic VA ablation.
• Prompt recognition and appropriate management are essential for improving outcomes.
• Implementing comprehensive measures to mitigate the risk of AD during these procedures is strongly recommended.