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Address reprint requests and correspondence: Dr. Francis E. Marchlinski, Cardiovascular Division, Hospital of The University of Pennsylvania, 9 Founders, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
demonstrating initiation of atrial fibrillation (AF) by pulmonary vein (PV) depolarizations
led to the development of percutaneous catheter-based endocardial AF ablation procedure.
Since its original description, the AF ablation procedure has evolved considerably.
Currently, the most accepted ablation strategy involves creating circumferential radiofrequency
(RF) ablation lesions around PV ostia (either individually or encircling wide areas
around the left-sided and right-sided veins) with or without additional atrial lesions.
However, creating these lesions uses multiple intracardiac catheters and requires
a significant degree of “invasiveness” while maintaining high levels of anticoagulation,
all of which make possible the occurrence of various potentially life-threatening
complications. In a summary of a worldwide survey of >8,000 patients who underwent
catheter ablation for AF, Cappato et al
report an overall 4% occurrence of complications such as pericardial effusion–cardiac
tamponade, cerebrovascular events, and PV stenosis. This compilation provides a reasonable
estimate of overall risk associated with the procedure in the general electrophysiology
community. The purpose of this article is to provide the readers with a concise review
on how to diagnose and manage the common complications that may be encountered in
patients undergoing the AF ablation procedure (Figure 1). In general, the majority of these complications typically are encountered early (during
or within 48 hours of completing the procedure), although some (PV stenosis, esophageal
fistula) may occur beyond the index hospitalization. Similarly, whereas the majority
of these complications manifest dramatic symptoms and distinct physical signs, a few
of them can have an insidious onset and/or remain completely asymptomatic.
Incidence of asymptomatic cerebral embolism associated with cooled-tip pulmonary vein ablation: a study using segmental ostial ablation and cerebral diffusion weighted magnetic resonance imaging (abstr).