Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 81(21), 2089–2099. https://doi.org/10.1016/j.jacc.2023.03.418 Dr. Karim Benali et al.
Points
- Catheter ablation of atrial fibrillation (AF) is a safe procedure with low procedure-related complications and mortality rates.
- A systematic review and pooled analysis of 89 studies involving 15,701 patients revealed an overall procedure-related complication rate of 4.51%, with severe complications occurring at a rate of 2.44%.
- Vascular complications were the most frequent type of complication (1.31%), followed by pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%).
- There has been a decline in complication rates over the past decade, with a significantly lower complication rate in the most recent 5-year period compared to the earlier 5-year period (3.77% vs. 5.31%).
- Factors such as the pattern of AF, ablation modality, and ablation strategies beyond pulmonary vein isolation did not significantly affect the complication rate.
Summary
This research paper presents a systematic review and pooled analysis of 89 studies, including 15,701 patients, to determine the rate of procedure-related complications in catheter ablation of atrial fibrillation (AF) using radiofrequency or cryoballoon. The overall procedure-related complication rate was 4.51% (95% CI: 3.76%-5.32%), with severe complications occurring at 2.44% (95% CI: 1.98%-2.93%). Among the various complications, vascular complications were the most frequent, accounting for 1.31% of cases, followed by pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%).
One significant finding of this study was the temporal trend in complication rates. The procedure-related complication rate during the most recent 5-year publication period was significantly lower than during the earlier 5-year period, with rates of 3.77% and 5.31%, respectively (P = 0.043). This suggests a decline in complications over time, indicating potential improvements in procedural techniques and patient management strategies. However, the pooled mortality rate remained stable over the two periods, with rates of 0.06% and 0.05%, respectively (P = 0.892).
Furthermore, the study explored the influence of various factors on complication rates. It was found that there was no significant difference in complication rates based on the pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation. This indicates that these factors do not significantly impact the overall occurrence of complications. These findings contribute to a better understanding of the safety profile of AF catheter ablation and provide clinicians with insights into optimizing procedural approaches.
In summary, this systematic review and pooled analysis demonstrate that catheter ablation of AF is associated with low rates of procedure-related complications and mortality. The study reveals a decline in complication rates over the past decade while the mortality rate remained stable. Vascular complications were the most common, highlighting the importance of careful monitoring and management. The findings emphasize the safety and efficacy of catheter ablation as a treatment option for AF and provide valuable insights for clinical practice and future research endeavors.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S0735109723052312
References Benali, K., Khairy, P., Hammache, N., Petzl, A., Da Costa, A., Verma, A., Andrade, J. G., & Macle, L. (2023). Procedure-related complications of catheter ablation for atrial fibrillation. Journal of the American College of Cardiology, 81(21), 2089–2099. https://doi.org/10.1016/j.jacc.2023.03.418
