Predictors of Cardiac Perforation With Catheter Ablation of Atrial Fibrillation.

Journal Article (Journal Article)

OBJECTIVES: This study identified factors associated with risk for cardiac perforation in the setting of atrial fibrillation (AF) ablation in contemporary clinical practice. BACKGROUND: Cardiac perforation is an uncommon but potentially fatal complication of AF ablation. An improved understanding of factors associated with cardiac perforation could facilitate improvements in procedural safety. METHODS: Logistic regression models were used to assess predictors of cardiac perforation among Medicare beneficiaries who underwent AF ablation from July 1, 2013 and December 31, 2017. Cardiac perforation was defined as a diagnosis of hemopericardium, cardiac tamponade, or pericardiocentesis, within 30 days of AF ablation. RESULTS: Of 102,398 patients who underwent AF ablation, 0.61% (n = 623) experienced cardiac perforation as a procedural complication. Rates of cardiac perforation decreased over time. In adjusted analyses of the overall population, female sex (odds ratio [OR]: 1.34; 95% confidence interval [CI]: 1.14 to 1.58; p = 0.0004), obesity (OR: 1.35; 95% CI: 1.09 to 1.68; p = 0.0050), and absence of intracardiac echocardiography (ICE) (OR: 4.85; 95% CI: 4.11 to 5.71; p < 0.0001) were associated with increased risk for cardiac perforation, whereas previous cardiac surgery (OR: 0.14; 95% CI: 0.07 to 0.26; p < 0.0001) was associated with a lower risk for perforation. Patient risk factors for cardiac perforation were identical in the subset of patients in whom ICE was used (n = 76,134). A risk score was generated with the following point assignments: female sex (1 point); obesity (1 point); nonuse of ICE (5 points); and previous cardiac surgery (-6 points). CONCLUSIONS: Cardiac perforation is a rare complication of AF ablation; incidence has decreased over time. One of the strongest predictors of cardiac perforation in the contemporary era is a modifiable factor, use of intraprocedural ICE.

Full Text

Duke Authors

Cited Authors

  • Friedman, DJ; Pokorney, SD; Ghanem, A; Marcello, S; Kalsekar, I; Yadalam, S; Akar, JG; Freeman, JV; Goldstein, L; Khanna, R; Piccini, JP

Published Date

  • June 2020

Published In

Volume / Issue

  • 6 / 6

Start / End Page

  • 636 - 645

PubMed ID

  • 32553212

Electronic International Standard Serial Number (EISSN)

  • 2405-5018

Digital Object Identifier (DOI)

  • 10.1016/j.jacep.2020.01.011

Language

  • eng

Conference Location

  • United States