PROCEDURE COMPLEXITY AND COMPLICATIONS IN PULMONARY VEIN ABLATIONS

Abstract

Atrial Fibrillation a common arrhythmia with a high burden of disease. When medical management fails, pulmonary vein ablation (PVA) can be an effective therapy to treat AF. The most common target for ablation is isolation of the pulmonary veins. Depending on the nature of the AF, additional ablation lesion sets (eg. left atrial roof line, mitral isthmus line, fractionation ablation) may be necessary. Complications from a PVA can be serious, with a risk estimated at approximately 4%. To determine if ablation procedures that involve extra lesions sets in addition to pulmonary vein isolation result in increased complication rates. In this retrospective cohort study, we examined 1374 PVAs performed from 2009 to 2017. Of these, 984 were categorized as simple ablations (pulmonary vein isolation alone) and 390 were categorized as complex (left atrial roof line, mitral isthmus line, or fractionation ablation). Rates of serious complications (tamponade, congestive heart failure, stroke/TIA) and all complications (groin injury, bleed, and other in addition to serious complications) were assessed and compared between simple and complex procedures. Complex procedures had a significantly greater number of ablations (31 vs 21, p = 0.01), longer ablation duration (43 vs. 36 minutes, p < 0.01), longer total fluoroscopy time (20 vs 19 minutes, p = 0.04) and longer procedure time (244 vs 217 minutes, p < 0.01) than simple ablations. Serious complications rates were 1.93% and 2.31% for simple and complex procedures respectively, however the difference between them was not statistically significant (p = 0.67). There was also no statistically significant difference in total complication rates, which were 7.22% and 7.69% for simple and complex procedures respectively (p = 0.76). Complex ablations do require more ablations, more ablation time, increased fluoroscopy time, and increased procedure time. However, we detected no increased overall complication risk comparing complex ablations with simple ablations.