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. 2017 Sep 15;20(1):157–208. doi: 10.1093/europace/eux275

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 388,396–401
Asymptomatic cerebral emboli (ACE) 2% to 15% Anticoagulation, catheter and sheath management, TEE Brain MRI None 402–419
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 337–365,420–456
Cardiac tamponade 0.2% to 5% Cather manipulation, transseptal technique, reduce power, force, and RF time Echocardiography Pericardiocentesis or surgical drainage 338,343,347,457–467
Coronary artery stenosis/occlusion <0.1% Avoid high-power energy delivery near coronary arteries Cardiac catheterization PTCA 468–476
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 478–490
Mitral valve entrapment <0.1% Avoid circular catheter placement near or across mitral valve; clockwise torque on catheter Echocardiography Gentle catheter manipulation, surgical extraction 491–498
Pericarditis 0% to 50% None proven Clinical history, ECG, sedimentation rate, echocardiogram NSAID, colchicine, steroids 499–506
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 9,11,156,347,367,446,457,478,479,487–490,507–528
Pulmonary vein stenosis <1% Avoid energy delivery within PV CT or MRI, V/Q wave scan Angioplasty, stent, surgery 9,11,313,316–335,457,529–531
Radiation injury <0.1% Minimize fluoroscopy exposure, especially in obese and repeat ablation patients, X-ray equipment None Supportive care, rarely skin graft 513,532–550
Stiff left atrial syndrome <1.5% Limit extent of left atrial ablation Echocardiography, cardiac catheterization Diuretics 551–558
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 10–13,338,347,367,458,559–565
Vascular complications 0.2% to 1.5% Vascular access techniques, ultrasound-guided access, anticoagulation management Vascular ultrasound, CT scan Conservative treatment, surgical repair, transfusion 338,347,371,373,374,380,458,511,566–575

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.