Key result
Female sex is linked to ~73% higher PVI complication risk independent of CHA2DS2-VASc scores.
Why the study?
Does the choice of ablation technique affect the complication rate of pulmonary vein isolation in patients with atrial fibrillation?
Observational (n=1,000)
Does the choice of ablation technique affect the complication rate of pulmonary vein isolation in patients with atrial fibrillation?
The overall complication rate of PVI is 10.5%, with female sex and higher CHA2DS2-VASc scores increasing risk, while complication profiles vary significantly by ablation technique.
Women and higher-CHA2DS2-VASc patients may face elevated PVI complication risk; observational data leaves open technique-specific safety differences.
Aims: To define predictors of complications of pulmonary vein isolation (PVI) and compare safety between different ablation techniques. Methods and results: One thousand patients with atrial fibrillation (AF) (age 60 ± 10, 72% males, CHA2DS2-VASc score 1 ± 1) underwent PVI using various techniques: conventional PVI (CPVI) using mapping with irrigated point-per-point RF ablation (n = 576), multi-electrode RF ablation with the pulmonary vein ablation catheter (PVAC) (n = 272) or high density mesh ablator (HDMA) (n = 59) and cryoballoon (CB) ablation (n = 93). A complication was defined as any procedure-related adverse event resulting in permanent injury or death, requiring intervention or treatment, or prolonging/requiring hospitalization for >48 h. A total of 105 (10.5%) complications occurred in 101 (10.1%) patients. No periprocedural death occurred. Most frequent complications were vascular complications (4%) and pericarditis (3.1%). Seven patients experienced permanent deficit due to PV stenosis (n = 3, 1 CPVI, 2 PVAC) (n = 3) and phrenic nerve palsy (PNP) (n = 4, 3 CPVI, 1 PVAC). Independent predictors of complications were female sex [odds ratio (OR) = 1.73; 95% confidence interval (CI) 1.08-2.79; P = 0.023], CHA2DS2-VASc score (OR = 1.24; 95% CI 1.01-1.52; P = 0.039), and ablation technique (P = 0.006) in multivariable-adjusted analysis. Among the different techniques, CB (P = 0.047) and PVAC ablation (P = 0.003) had lowest overall complication rates. Complication profile (type/severity) differed between techniques (association between CB and PNP, CPVI and pericardial injury, PVAC and transient ischaemic attack/PV stenosis). Conclusion: Overall complication rate of PVI with various techniques is 10.5%. Permanent deficit occurred only after PVAC and CPVI in 0.7% of patients. Female sex and a higher CHA2DS2-VASc score increase, while PVAC and CB-PVI decrease, overall risk. Differences in overall safety and individual complication profile make selection of the ablation technique in relation to clinical risk profile possible.
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Greef et al. (2017) conducted an observational in Atrial fibrillation (n=1,000). Pulmonary vein isolation (CPVI, PVAC, HDMA, or cryoballoon) vs. Comparison between ablation techniques was evaluated on Procedure-related complications. Pulmonary vein isolation had an overall complication rate of 10.5%, with female sex (OR 1.73; 95% CI 1.08-2.79) and higher CHA2DS2-VASc score independently predicting increased complication risk.
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