title: Outcomes of cardiac perforation complicating catheter ablation of ventricular arrhythmias.
abstract: BACKGROUND
  Cardiac perforation is a recognized complication of catheter ablation procedures, most commonly encountered during ablation of atrial fibrillation. The study aims to investigate the incidence, management, and hospital outcomes of cardiac perforation complicating catheter ablation for ventricular arrhythmias.
  
  
  RESULTS
  Consecutive patients undergoing catheter ablation for ventricular arrhythmias at a tertiary referral center were included in this retrospective analysis. Of 1152 consecutive catheter ablation procedures in 892 patients over 12 years, 11 procedures (1.0%) were complicated by ventricular perforation. Emergent pericardial drainage and surgical repair were required in 10 (91%) and 6 (55%) cases, respectively. No perforation was apparent in patients with prior cardiac surgery. More than half of the perforations (6 of 11) occurred in the context of steam pops during radiofrequency ablation and were more likely to require surgical repair (P=0.07). Intra-aortic balloon counterpulsation, left ventricular assist device, and biventricular assist device were used in 2 patients, 1 patient, and 1 patient, respectively. Of 6 cases in which the site of perforation could be determined at cardiac surgery, 5 were in the right ventricle (4 outflow tract, 1 free wall) and only 1 was located in the left ventricle. All patients survived to discharge.
  
  
  CONCLUSIONS
  Ventricular perforation and tamponade occurs in 1% of ventricular ablation procedures and in this series, occurred only in patients without a history of prior cardiac surgery. More than half the patients required surgical repair. Perforation is often associated with steam pops and emergent surgical repair is often required when perforation occurs after a steam pop.
authors.affiliation: Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Michifumi
authors.initials: M
authors.lastname: Tokuda
authors.forename: Pipin
authors.initials: P
authors.lastname: Kojodjojo
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Koplan
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
mesh_terms: D000328:Adult; D000368:Aged; D057791:Cardiac Imaging Techniques; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000453:epidemiology / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography