Thromboembolic complications of cardiac radiofrequency catheter ablation: a review of the reported incidence, pathogenesis and current research directions.
BACKGROUND
Radiofrequency catheter ablation (RFCA) has become established as an effective therapy for the treatment of many cardiac tachyarrhythmias. The principle limitation of conventional RFCA continues to be the risk of thromboembolism. This risk is of particular concern for the ongoing development of the catheter maze procedure for the treatment of atrial fibrillation, which currently involves the creation of extensive linear lesions in the left atrium.


RESULTS
A Medline search of the literature over the last ten years was performed. Focused review of the reported thromboembolic complications of RFCA indicates an overall incidence of 0.6%. However, the risk is increased when ablation is performed in the left heart (1.8% to 2%) and for ventricular tachycardia (2.8%). It is of concern that intravenous heparin and the use of temperature feedback to control radiofrequency current do not eliminate the risk of thromboembolic events.


CONCLUSIONS
The thromboembolic complications of RFCA are not eliminated by the treatment of intravenous herapin and mode of temperature control during ablation. Potential approaches to further reduce the risk of thromboembolism include the adjunctive administration of specific inhibitors of platelet activation and aggregation, intraprocedural intracardiac echocardiography, irrigated radiofrequency ablation, and cryoablation catheter systems.
Zhou
L
L
Cardiac Unit, Massachusetts General Hospital and Cardiovascular Biology Laboratory, Harvard School of Public Health, Boston 02114, USA.
Keane
D
D
Reed
G
G
Ruskin
J
J
D000925:Anticoagulants / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D016343:Monitoring, Intraoperative; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin