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 | 803,1218-1223 |
| Asymptomatic cerebral emboli (ACE) | 2% to 15% | Anticoagulation, catheter and sheath management, TEE | Brain MRI | None | 723,724,728,731,800,1205-1217 |
| Atrial esophageal 3stula | 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 | 637,705,806,866,877-920,1162-1178,1398 |
| Cardiac tamponade | 0.2% to 5% | Cather manipulation, transseptal technique, reduce power, force, and RF time | Echocardiography | Pericardiocentesis or surgical drainage | 482,806,908,920,921,1034,1131-1135,1139-1141 |
| Coronary artery stenosis/occlusion | <0.1% | Avoid high-power energy delivery near coronary arteries | Cardiac catheterization | PTCA | 923,1233-1240 |
| Death | <0.1% to 0.4% | Meticulous performance of procedure, attentive postprocedure care | NA | NA | 921,806,908,920,1039 |
| Gastric hypomotility | 0% to 17% | Reduce power, force, and RF time on posterior wall | Endoscopy, barium swallow, gastric emptying study | Metoclopramide, possibly intravenous erythromycin | 536,1017-1021,1179-1185 |
| Mitral valve entrapment | <0.1% | Avoid circular catheter placement near or across mitral valve; clockwise torque on catheter | Echocardiography | Gentle catheter manipulation, surgical extraction | 1263-1269,1396 |
| Pericarditis | 0% to 50% | None proven | Clinical history, ECG, sedimentation rate, echocardiogram | NSAID, colchicine, steroids | 985,986,1257-1262 |
| 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 | 462,482,490,503,532,533,536,706,707,779,808,903,920,1017,1075,1182-1201 |
| Pulmonary vein stenosis | <1% | Avoid energy delivery within PV | CT or MRI, V/Q wave scan | Angioplasty, stent, surgery | 244,434,462,482,498,503,927,928,1142-1160 |
| Radiation injury | <0.1% | Minimize fluoroscopy exposure, especially in obese and repeat ablation patients, X-ray equipment | None | Supportive care, rarely skin graft | 747,749,763,1186,1241-1256 |
| Stiff left atrial syndrome | <1.5% | Limit extent of left atrial ablation | Echocardiography, cardiac catheterization | Diuretics | 1110,1111,1270-1275 |
| 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 | 242,489,503,532,655,673,796,798,799,806,920,921,1202-1204 |
| Vascular complications | 0.2% to 1.5% | Vascular access techniques, ultrasound-guided access, anticoagulation management | Vascular ultrasound, CT scan | Conservative treatment, surgical repair, transfusion | 806-808,834,840-842,920,921,1224-1232 |
AF = atrial fibrillation; CT = computed tomography; MRI = magnetic resonance imaging; TEE 5transesophageal 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.