AB-452642-1 TEMPORAL TREND IN PROCEDURE-RELATED COMPLICATIONS OF CATHETER ABLATION FOR ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND POOLED ANALYSIS OF RANDOMIZED CONTROL TRIALS.

Abstract

Catheter ablation of atrial fibrillation (AF) is one of the most commonly performed procedures in electrophysiology. However, it is associated with potentially significant complications. Reported procedure-related complication rates are highly variable, depending in part on study design. Objectives of this systematic review and pooled analysis were to determine the rate of procedure-related complications associated with catheter ablation of AF using data from randomized control trials (RCTs), and to assess temporal trends. MEDLINE and EMBASE databases were searched from January 2013 to September 2022 for RCTs that included patients undergoing a first catheter ablation procedure for the treatment of AF using either radiofrequency or cryoballoon ablation (PROSPERO CRD42022370273). The study adhered to Cochrane Collaboration guidelines. The quality of included trials was assessed using the Cochrane Collaboration’s tool for assessing risk of bias in RCTs. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses report. A total of 1,468 references were retrieved and evaluated, of which 89 studies met inclusion criteria. A total of 15,701 patients who underwent a first catheter ablation procedure for AF were included in the current analysis. Procedure-related and severe complication rates were 3.5% (95%CI: 2.9-4.1) and 2.1% (95%CI: 1.7-2.5), respectively. Vascular complications were the most frequent type of complication (1.21%). The most frequently reported complications were then pericardial effusions and tamponades (0.51%), strokes/transient ischemic attacks (0.48%) and reversible phrenic nerve palsy (0.40%). The procedure-related complication rate during the most recent 5-year period of publication [2018-2022] was significantly lower than during the earlier 5-year period [2013-2017] (2.9% vs 4.1%, p=0.043). The pooled mortality rate was stable over the two time periods (0.06% vs 0.05%, p=0.562). By meta-regression analyses, there was no significant difference in complication rate according to pattern of AF (paroxysmal or non-paroxysmal), ablation modality (radiofrequency or cryoballoon), or additional ablation strategies beyond pulmonary vein isolation. Procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade.