Table 9.
Incidence, prevention, diagnosis, and treatment of selected complications of AF ablation
| Complication | Incidence | Selected prevention techniques | Diagnostic testing | Selected treatment options | References |
|---|---|---|---|---|---|
| Air embolism | <1% | Sheath management | Nothing or cardiac catheterization | Supportive care with fluid, oxygen, head down tilt, hyperbaric oxygen | 388, 396, 397, 398, 399, 400, 401 |
| Asymptomatic cerebral emboli (ACE) | 2% to 15% | Anticoagulation, catheter and sheath management, TEE | Brain MRI | None | 402, 403, 404, 405, 406, 407, 408, 409, 410, 411, 412, 413, 414, 415, 416, 417, 418, 419 |
| Atrial esophageal fistula | 0.02% to 0.11% | Reduce power, force, and RF time on posterior wall, monitor esophageal temp, use proton pump inhibitors; avoid energy delivery over esophagus | CT scan of chest, MRI; avoid endoscopy with air insufflation | Surgical repair | 337, 338, 339, 340, 341, 342, 343, 344, 345, 346, 347, 348, 349, 350, 351, 352, 353, 354, 355, 356, 357, 358, 359, 360, 361, 362, 363, 364, 365, 420, 421, 422, 423, 424, 425, 426, 427, 428, 429, 430, 431, 432, 433, 434, 435, 436, 437, 438, 439, 440, 441, 442, 443, 444, 445, 446, 447, 448, 449, 450, 451, 452, 453, 454, 455, 456 |
| Cardiac tamponade | 0.2% to 5% | Cather manipulation, transseptal technique, reduce power, force, and RF time | Echocardiography | Pericardiocentesis or surgical drainage | 338, 343, 347, 457, 458, 459, 460, 461, 462, 463, 464, 465, 466, 467 |
| Coronary artery stenosis/occlusion | <0.1% | Avoid high-power energy delivery near coronary arteries | Cardiac catheterization | PTCA | 468, 469, 470, 471, 472, 473, 474, 475, 476 |
| Death | <0.1% to 0.4% | Meticulous performance of procedure, attentive postprocedure care | NA | NA | 338, 343, 347, 458, 477 |
| Gastric hypomotility | 0% to 17% | Reduce power, force, and RF time on posterior wall | Endoscopy, barium swallow, gastric emptying study | Metoclopramide, possibly intravenous erythromycin | 478, 479, 480, 481, 482, 483, 484, 485, 486, 487, 488, 489, 490 |
| Mitral valve entrapment | <0.1% | Avoid circular catheter placement near or across mitral valve; clockwise torque on catheter | Echocardiography | Gentle catheter manipulation, surgical extraction | 491, 492, 493, 494, 495, 496, 497, 498 |
| Pericarditis | 0% to 50% | None proven | Clinical history, ECG, sedimentation rate, echocardiogram | NSAID, colchicine, steroids | 499, 500, 501, 502, 503, 504, 505, 506 |
| Permanent phrenic nerve paralysis | 0% to 0.4% | Monitor diaphragm during phrenic pacing, CMAP monitoring, phrenic pacing to identify location and adjust lesion location | CXR, sniff test | Supportive care | 9, 11, 156, 347, 367, 446, 457, 478, 479, 487, 488, 489, 490, 507, 508, 509, 510, 511, 512, 513, 514, 515, 516, 517, 518, 519, 520, 521, 522, 523, 524, 525, 526, 527, 528 |
| Pulmonary vein stenosis | <1% | Avoid energy delivery within PV | CT or MRI, V/Q wave scan | Angioplasty, stent, surgery | 9, 11, 313, 316, 317, 318, 319, 320, 321, 322, 323, 324, 325, 326, 327, 328, 329, 330, 331, 332, 333, 334, 335, 457, 529, 530, 531 |
| Radiation injury | <0.1% | Minimize fluoroscopy exposure, especially in obese and repeat ablation patients, X-ray equipment | None | Supportive care, rarely skin graft | 513, 532, 533, 534, 535, 536, 537, 538, 539, 540, 541, 542, 543, 544, 545, 546, 547, 548, 549, 550 |
| Stiff left atrial syndrome | <1.5% | Limit extent of left atrial ablation | Echocardiography, cardiac catheterization | Diuretics | 551, 552, 553, 554, 555, 556, 557, 558 |
| Stroke and TIA | 0% to 2% | Pre-, post-, and intraprocedure anticoagulation, catheter and sheath management, TEE | Head CT or MRI, cerebral angiography | Thrombolytic therapy, angioplasty | 10, 11, 12, 13, 338, 347, 367, 458, 559, 560, 561, 562, 563, 564, 565 |
| Vascular complications | 0.2% to 1.5% | Vascular access techniques, ultrasound-guided access, anticoagulation management | Vascular ultrasound, CT scan | Conservative treatment, surgical repair, transfusion | 338, 347, 371, 373, 374, 380, 458, 511, 566, 567, 568, 569, 570, 571, 572, 573, 574, 575 |
AF = atrial fibrillation; CT = computed tomography; MRI = magnetic resonance imaging; TEE = transesophageal electrocardiogram; RF = radiofrequency; PTCA = percutaneous transluminal coronary angioplasty; NA = not applicable; ECG = electrocardiogram; NSAID = nonsteroidal anti-inflammatory drug; CMAP = compound motor action potentials; CXR = chest X-ray; TIA = transient ischemic attack.