Population-Based Evaluation of Major Adverse Events After Catheter Ablation for Atrial Fibrillation

Abstract

CA is a relatively safe procedure with low incidence of major AEs. The incidence of procedure-related CVA appeared to decline significantly over time. Incidence of PERD remained relatively stable and was more likely to be diagnosed after discharge and following repeat CA.

Population‐level evaluation of complications after catheter ablation in patients with atrial fibrillation and heart failure

“…Although prior evaluations of the incidence of major AEs in AF patients who underwent CA included a low proportion of patients with comorbid HF (0.4% to 18%), the incidence of major AEs between 1% and 6% did not differ from the present study which only included patients with comorbid HF . Only two studies indicated that HF was a predictor for major AEs (univariate HR 5.2 [95% CI, 2.0‐13.4]); however, the comparable incidence between the present study and the safety evaluations of all AF patients undergoing CA seems to indicate no increase in AE risk with the addition of HF.…”

“…Advanced age has consistently been identified as a predictor of major AEs amongst patients undergoing CA, regardless of the presence of HF . Coronary artery disease, however, was only identified as predictive of hemorrhage complications in Bertaglia et al (OR, 5.6 [95% CI, 1.6‐20.1]).…”

“…Only two studies indicated that HF was a predictor for major AEs (univariate HR 5.2 [95% CI, 2.0‐13.4]); however, the comparable incidence between the present study and the safety evaluations of all AF patients undergoing CA seems to indicate no increase in AE risk with the addition of HF. In addition to the presence of HF, the HF population who underwent CA was older and had a higher prevalence of all comorbidities compared to a prior study using the Quebec and Ontario AF cohorts which assessed the incidence of major AEs in all AF patients who underwent CA . Despite more comorbidities in AF‐HF patients undergoing CA and additional technical challenges of CA due to morphology changes in HF patients, the comparable rates of major AEs suggest that CA is safe to perform in AF patients with comorbid HF.…”

“…Although prior evaluations of the incidence of major AEs in AF patients who underwent CA included a low proportion of patients with comorbid HF (0.4% to 18%), the incidence of major AEs between 1% and 6% did not differ from the present study which only included patients with comorbid HF. 1,6,7,[10][11][12][13][14][15][16][17][18][19]36 Only two studies indicated that HF was a predictor for major AEs The ROCKET-AF 37 and ARISTOTLE 38 trials have identified the chronic obstructive pulmonary disorder as a predictor of all-cause mortality in the AF population. In addition, HAS-BLED risk score has been identified as a predictor of long-term adverse outcomes, including mortality, in the AF population as well as other cardiovascular diseases and postcardiac procedures.…”

“…incidence of major AEs is low in this patient population, ranging from 1% to 6%. 1,[6][7][8][9][10][11][12][13][14][15][16][17][18][19] In recent years, the use of CA has expanded to the treatment of AF in challenging subpopulations, including patients with comorbid heart failure (HF). Randomized trials have shown that the treatment with CA is associated with reduced all-cause mortality, HF hospitalizations, and strokes in patients with AF and HF.…”