Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation.
OBJECTIVE
The purpose of this study was to provide a systematic multicenter survey on the incidence and causes of death occurring in the setting of or as a consequence of catheter ablation (CA) of atrial fibrillation (AF).


BACKGROUND
CA of AF is considered to be generally safe. However, serious complications, including death, have been reported.


METHODS
Using a retrospective case series, data relevant to the incidence and cause of intra- and post-procedural death occurring in patients undergoing CA of AF between 1995 and 2006 were collected from 162 of 546 identified centers worldwide.


RESULTS
Thirty-two deaths (0.98 per 1,000 patients) were reported during 45,115 procedures in 32,569 patients. Causes of deaths included tamponade in 8 patients (1 later than 30 days), stroke in 5 patients (2 later than 30 days), atrioesophageal fistula in 5 patients, and massive pneumonia in 2 patients. Myocardial infarction, intractable torsades de pointes, septicemia, sudden respiratory arrest, extrapericardial pulmonary vein (PV) perforation, occlusion of both lateral PVs, hemothorax, and anaphylaxis were reported to be responsible for 1 death each, while asphyxia from tracheal compression secondary to subclavian hematoma, intracranial bleeding, acute respiratory distress syndrome, and esophageal perforation from an intraoperative transesophageal echocardiographic probe were causes of 1 late death each.


CONCLUSIONS
Death is a complication of CA of AF, occurring in 1 of 1,000 patients. Knowledge of possible precipitating causes is key to operators and needs to be considered during decision making with patients.
Arrhythmias and Electrophysiology Center, IRCCS Policlinico San Donato, Milan, Italy. rcappato@libero.it
Riccardo
R
Cappato
Hugh
H
Calkins
Shih-Ann
SA
Chen
Wyn
W
Davies
Yoshito
Y
Iesaka
Jonathan
J
Kalman
You-Ho
YH
Kim
George
G
Klein
Andrea
A
Natale
Douglas
D
Packer
Allan
A
Skanes
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality* / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality*; D003657:Decision Making; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult