. 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.