P346More procedural complications in female patients undergoing pulmonary vein ablation in atrium fibrillation: results from 12,430 patients in the Netherlands Heart Registry

Abstract

Abstract Introduction Pulmonary vein isolation (PVI) has become a cornerstone of the treatment of atrial fibrillation (AF). Several technologies have been developed to improve procedural and long-term outcomes. Depending on type of AF and rhythm recording used, 1-year freedom of AF varies between 55–82%. However, severe complications are reported in 1–3%. Purpose To describe procedural complications of PVI with either single tip radiofrequency ablation (STRF), multi electrode phased RF ablation (PVAC) or cryoballoon (CB). Methods Data was extracted from the Netherlands Heart Registry in which 14 Dutch heart centres participate. Procedural complications in patients treated with the 3 different ablation modalities (STRF, PVAC and CB ablation) were compared. Complications included: pericardial tamponade, persistent phrenic nerve palsy (PNP) beyond 24hrs, thromboembolic events, vascular- and bleeding complications. Patient characteristics: gender, age, BMI, CHA2DS2 -VASc, type of AF and previous left atrium ablation were assessed in a univariate and multivariate regression model. Results In total, 12,430 patients were included (STRF n=5,106, PVAC n=2,341, CB n=4,983) between January 2013 and December 2017, of whom, 69% were male, 74% had a history of paroxysmal AF, 24% persistent AF and 2% longstanding persistent AF. The incidence of complications within 30 days was 3.6%. Pericardial tamponade requiring intervention, occurred more frequently in the STRF group (STRF: 0.8% vs PVAC 0.3% vs CB 0.3% p= <0.01). PNP was present in 0.1% of patients after STRF ablation, in 0.2% of patients after PVAC ablation and in 1.5% of patients treated with CB ablation (p= <0.001). Thromboembolic events were observed in 0.4% with no statistical difference between the 3 modalities. Patients treated with STRF had more vascular complications (STRF 1.7% vs PVAC 1.2% vs CB 1.3% p= <0.001). In the PVAC and CB group there were significant less bleeding complications (STRF: 1.1% vs PVAC: 0.5% vs CB: 0.7% p=0.01). Female patients and patients with a higher CHA2DS2-VASc had an increased risk for pericardial tamponade, vascular- and bleeding complications (figure) with adjusted odds ratios for female patients of 2.97 (95% CI 1.77–5.00), 2.24 (95% CI 1.41–3.56) and 2.84 (95% CI 1.88–4.28) respectively. Univariate analysis Conclusion PVI was associated with a complication rate of 3.6%. Compared to PVAC and CB ablation, patients treated with STRF ablation more often developed a pericardial tamponade and vascular- and bleeding complications. PNP occurred most frequent in patients undergoing CB ablation. Female gender and CHA2DS2-VASc were independent predictors for pericardial tamponade, vascular- and bleeding complications.