Introduction:
Pulmonary vein (PV) isolation by
catheter ablation is an increasingly used strategy to treat
atrial fibrillation (AF). Complication rates from AF
ablation reported in different case series vary widely. We conducted a retrospective analysis of 641 consecutive
ablation procedures to assess complication rates,
temporal trends, and clinical predictors of
adverse outcomes. Methods: All patients (n = 517) undergoing
catheter ablation for AF at Johns Hopkins Hospital between February, 2001 and June, 2007 were prospectively enrolled in a database. Data from 641 consecutive procedures were analyzed and complications considered if they occurred within 30 days of
ablation. Major complications were defined as those that required intervention, resulted in long-term
disability, or prolonged hospitalization. Results: Thirty-two major complications occurred in 641 procedures (5%). Among the patients with major complications, seven had
cerebrovascular accident (CVA), eight had tamponade, one had PV occlusion with
hemoptysis, and 11 had vascular
injury requiring
surgical repair and/or
transfusion. No periprocedural deaths occurred, and no instances of esophageal
injury were seen. Complication rates were higher during the first 100 cases (9.0%) than during the subsequent 541 (4.3%). Major adverse clinical events were associated with age > 70 years (P = 0.007;
odds ratio 3.7, 95%
confidence interval 1.4-9.6) and female gender (P = 0.014;
odds ratio 3.0, 95%
confidence interval 1.3-7.2). No other clinical or procedural predictors of complication were identified. Conclusions: Complication rates from AF
ablation remain significant, despite improved techniques and increased
awareness of procedural risks. Both
advanced age and female gender predict major
adverse events, suggesting careful consideration of the risk/benefit profile in these patients
prior to
ablation.
