title: Complications arising from catheter ablation of atrial fibrillation: temporal trends and predictors.
abstract: BACKGROUND
  The reported complication rate of catheter ablation of atrial fibrillation (AF) varies.
  
  
  OBJECTIVE
  Our goal was to assess temporal trends and the effect of both institutional and individual operators' experience on the incidence of complications.
  
  
  METHODS
  All patients undergoing AF ablation at Johns Hopkins Hospital between February 2001 and December 2010 were prospectively enrolled in a database. Major complications were defined as those that were life-threatening, resulted in permanent harm, required intervention, or significantly prolonged hospitalization.
  
  
  RESULTS
  Fifty-six major complications occurred in 1190 procedures (4.7%). The majority of complications were vascular (18; 1.5%), followed by pericardial tamponade (13; 1.1%) and cerebrovascular accident (12; 1.1%). No cases of death or atrioesophageal fistula occurred. The overall complication rate decreased from 11.1% in 2002 to 1.6% in 2010 (P <.05). On univariate analysis, demographic and clinical factors associated with the increased risk of complications were CHADS(2) score of ≥2 (hazard ratio [HR] = 2.5; 95% confidence interval [CI] = 1.4-4.4; P = .002), female gender (HR = 2.0; 95% CI = 1.2-3.5; P = .014), and age (HR = 1.03; 95% CI = 1.0-1.1; P = .042). Gender and CHADS(2) score of ≥2 remained independent predictors of complication on multivariable analysis.
  
  
  CONCLUSIONS
  The complication rate of catheter ablation of AF decreased with increased institutional experience. Female gender and CHADS(2) score of ≥2 are significant independent risk factors for complications and should be considered when referring patients for AF ablation.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Hana
authors.initials: H
authors.lastname: Hoyt
authors.forename: Aditya
authors.initials: A
authors.lastname: Bhonsale
authors.forename: Karuna
authors.initials: K
authors.lastname: Chilukuri
authors.forename: Fawaz
authors.initials: F
authors.lastname: Alhumaid
authors.forename: Matthew
authors.initials: M
authors.lastname: Needleman
authors.forename: David
authors.initials: D
authors.lastname: Edwards
authors.forename: Ashul
authors.initials: A
authors.lastname: Govil
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
authors.forename: Charles A
authors.initials: CA
authors.lastname: Henrikson
authors.forename: Sunil
authors.initials: S
authors.lastname: Sinha
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: David D
authors.initials: DD
authors.lastname: Spragg
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D015142:Baltimore / Q000453:epidemiology; D002305:Cardiac Tamponade / Q000453:epidemiology / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology