Four types of complications in paroxysmal atrial fibrillation ablation

This editorial refers to ‘Pericardial effusion in atrial fibrillation ablation: a comparison between cryoballoon and radiofrequency pulmonary vein isolation’ by G.B. Chierchia et al., on page 337. A recent worldwide survey shows that radiofrequency (RF) catheter ablation of paroxysmal atrial fibrillation (AF) is associated with a success rate of 75% without antiarrhythmic drugs, with major complications still occurring in 4‐5% of the patients. 1 This drives a continuous quest for a more effective and safer ablation approach. Currently, the use of robotic navigation systems, alternative forms of energy (ultrasound, cryo-energy, laser, microwave, and infrared), and the use of ‘single-shot’ devices (e.g. cryoballoon, multi-electrode ablation catheters) are under investigation. In the present paper Chierchia et al. report on the safety of cryoballoon-based pulmonary vein isolation. 2 In general, it is hypothesized that cryoballoon ablation of AF is a safer approach, but neither survey nor large randomized trials are available. To address the safety of new technologies, we suggest classifying known AF complications (tamponade, radiation exposure, embolic events, pulmonary vein stenosis, atrio-oesophageal fistula, phrenic nerve palsy, and groin problems) into four partly overlapping categories (Figure 1). Operator experience and patient profile always act as modulating factors.