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.
Cappato
Riccardo
R
Arrhythmias and Electrophysiology Center, IRCCS Policlinico San Donato, Milan, Italy. rcappato@libero.it
Calkins
Hugh
H
Chen
Shih-Ann
SA
Davies
Wyn
W
Iesaka
Yoshito
Y
Kalman
Jonathan
J
Kim
You-Ho
YH
Klein
George
G
Natale
Andrea
A
Packer
Douglas
D
Skanes
Allan
A
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