title: Effects of sex on the incidence of cardiac tamponade after catheter ablation of atrial fibrillation: results from a worldwide survey in 34 943 atrial fibrillation ablation procedures.
abstract: BACKGROUND
  Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female sex is a known risk factor for complications during AF ablation; however, it is unknown whether women have a higher risk of tamponade.
  
  
  RESULTS
  A systematic Medline search was used to locate academic electrophysiological centers that reported cases of tamponade occurring during AF ablation. Centers were asked to provide information on cases of acute tamponade according to sex and their mode of management including any case of related mortality. Nineteen electrophysiological centers provided information on 34 943 ablation procedures involving 25 261 (72%) men. Overall, 289 (0.9%) cases of tamponade were reported: 120 (1.24%) in women and 169 (0.67%) in men (odds ratio, 1.83; P<0.001). There was a reciprocal association between center volume and the occurrence of tamponade with substantially lower risk in high-volume centers. Most cases of tamponade occurred during catheter manipulation or ablation; women tended to develop more tamponades during transseptal catheterization. No sex difference in the mode of management was observed. However, 16% cases of tamponade required surgery with lower rates in high-volume centers. Three cases of tamponade (1%) culminated in death.
  
  
  CONCLUSIONS
  Tamponade during AF ablation procedures is relatively rare. Women have an ≈2-fold higher risk for developing this complication. The risk of tamponade among women decreases substantially in high-volume centers. Surgical backup and acute management skills for treating tamponade are important in centers performing AF ablation.
authors: Yoav
authors: Y
authors: Michowitz
authors: Michael
authors: M
authors: Rahkovich
authors: Hakan
authors: H
authors: Oral
authors: Erica S
authors: ES
authors: Zado
authors: Roland
authors: R
authors: Tilz
authors: Silke
authors: S
authors: John
authors: Arnaud
authors: A
authors: Denis
authors: Luigi
authors: L
authors: Di Biase
authors: Roger A
authors: RA
authors: Winkle
authors: Evgeny N
authors: EN
authors: Mikhaylov
authors: Jeremy N
authors: JN
authors: Ruskin
authors: Yan
authors: Y
authors: Yao
authors: Mark E
authors: ME
authors: Josephson
authors: Hildegard
authors: H
authors: Tanner
authors: John M
authors: JM
authors: Miller
authors: Jean
authors: J
authors: Champagne
authors: Paolo
authors: P
authors: Della Bella
authors: Koichiro
authors: K
authors: Kumagai
authors: Pascal
authors: P
authors: Defaye
authors: David
authors: D
authors: Luria
authors: Dmitry S
authors: DS
authors: Lebedev
authors: Andrea
authors: A
authors: Natale
authors: Pierre
authors: P
authors: Jais
authors: Gerhard
authors: G
authors: Hindricks
authors: Karl-Heinz
authors: KH
authors: Kuck
authors: Francis E
authors: FE
authors: Marchlinski
authors: Fred
authors: F
authors: Morady
authors: Bernard
authors: B
authors: Belhassen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery*; D002305:Cardiac Tamponade / Q000453:epidemiology* / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects*; D003625:Data Collection; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: atrial fibrillation; cardiac tamponade; catheter ablation; sex