Key result
AF catheter ablation complication rates drop ~29% over the past decade.
Why the study?
Reported procedure-related complication rates for catheter ablation of AF are highly variable, partly depending on study design.
Systematic Review (n=15,701)
Procedure-related complications for first-time atrial fibrillation ablation are relatively low (4.51%) and have significantly declined over the past decade, with stable and very low mortality.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“this report yields clinically important information allowing the clinician and patient to make a more informed decision regarding choosing ablation”
“Periprocedural complication rates and mortality associated with a first catheter ablation procedure for AF are low. A significant improvement in the safety profile of the procedure was observed over the last five years. Neither the type of energy used for ablation nor the creation of additional lesions on top of PVI significantly influenced the procedural complication rate.”
Enables informed AF ablation decisions for clinicians and patients; confirms enhanced procedural safety with technological advances.
BACKGROUND Catheter ablation of atrial fibrillation (AF) is a commonly performed procedure. However, it is associated with potentially significant complications. Reported procedure-related complication rates are highly variable, depending in part on study design. OBJECTIVES The purpose of this systematic review and pooled analysis was to determine the rate of procedure-related complications associated with catheter ablation of AF using data from randomized control trials and to assess temporal trends. METHODS MEDLINE and EMBASE databases were searched from January 2013 to September 2022 for randomized control trials that included patients undergoing a first ablation procedure of AF using either radiofrequency or cryoballoon (PROSPERO, CRD42022370273). RESULTS A total of 1,468 references were retrieved, of which 89 studies met inclusion criteria. A total of 15,701 patients were included in the current analysis. Overall and severe procedure-related complication rates were 4.51% (95% CI: 3.76%-5.32%) and 2.44% (95% CI: 1.98%-2.93%), respectively. Vascular complications were the most frequent type of complication (1.31%). The next most common complications were pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%). The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.77% vs 5.31%; P = 0.043). The pooled mortality rate was stable over the 2 time periods (0.06% vs 0.05%; P = 0.892). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation. CONCLUSIONS Procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade.
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Bénali et al. (2023) conducted a systematic review in Atrial fibrillation (n=15,701). Catheter ablation was evaluated on Overall procedure-related complication rate (95% CI 3.76%-5.32%). Catheter ablation for atrial fibrillation had an overall procedure-related complication rate of 4.51%, which declined from 5.31% to 3.77% over the past decade.
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