įactors which have been proven to increase embolic risk are increased catheter time in the left atrium (LA), chronicity of AF, activated clotting time (ACT) below 250 seconds, duration of individual ablations, larger LA size, non-irrigated ablation and the presence of spontaneous echo contrast. The possible embolic sources are thrombus formation on the ablation electrode and sheath, debris from steam popping and charring, preexisting thrombus in the cardiac chamber, air embolus from within the sheath and fresh thrombus formed on damaged endothelial surface of endocardial lesions,. Therapeutic periprocedural anticoagulation significantly reduced ACL. The presence of spontaneous echo contrast and procedural duration before heparin administration were determinants of ACL. found 13–20% prevalence of cognitive dysfunction at three months in AF patients treated with ablation compared to none in those managed medically. An even higher incidence of 41% was reported by the MACAP study when more sensitive 3 Tesla MRI imaging was performed. Asymptomatic cerebral lesion (ACL) was common ranging from 10 to 14%. However, there is ample evidence to suggest that the subclinical cerebral embolism during left sided ablations especially pulmonary venous isolation (PVI) for AF is far more common. The reported incidence of clinical stroke in AF ablation is much less than 1%. Animal studies, in vitro studies, conference proceedings, case reports, comments, and surgical ablation articles were excluded. Prospective and retrospective designs, and review articles were included. Out of 5390 articles obtained through this search, 315 journal articles pertaining to safety issues of RF ablation were carefully studied for the review. Search terms namely radiofrequency ablation, safety, complications, AF, atrio ventricular reentry tachycardia (AVRT), atrio ventricular nodal reentry tachycardia (AVNRT), VT and atrial flutter (A Fl) were used separately and in combination. Pulmonary vein isolation (PVI) for AF ablation for SVT and VT ablation.Įlectronic database was searched for relevant articles from 1990 to 2015. For the purposes of this review we will consider three broad types of procedures. However the incidence of some chronic complications has risen, as procedures became more complex and time consuming.Ĭatheter ablation procedures are used to treat a diverse range of arrhythmias with vastly different natural histories and alternative treatment options. Even though procedure-related acute complications are on the decline by virtue of better knowledge of arrhythmia physiology, experience of particular group with RF ablation and advancements in technology like mapping, cryoablation and newer ablation techniques such as magnetic navigation. Achieving the optimal balance between efficacy and safety has proven to be challenging. RF ablation has been part of clinical practice for more than two decades and has become an important treatment option for most clinically relevant cardiac arrhythmias. Recent reports about the high incidence of asymptomatic cerebral embolism during AF ablation are concerning, warranting more research into its etiology and prevention. Up to 3% mortality and similar rates of tamponade were reported in endocardial VT ablation. Vascular and pericardial complications dominated endocardial and epicardial VT ablations respectively. In VT ablation the incidence of major complications was 5–11%, up to 3.4%, up to 1.8% and 4.1–8.8% in patients with structural heart disease, without structural heart disease, prophylactic ablations and epicardial ablations respectively. Safety of SVT ablation has also improved with less than 1% incidence of AV node injury in AVNRT ablation. In AF ablation it has decreased from 6% to less than 4% comprising of vascular complications, cardiac tamponade, stroke, phrenic nerve injury, pulmonary vein stenosis, atrio-esophageal fistula (AEF) and death. With better awareness and technological advancements in RF ablation the incidence of complications has improved considerably. Electronic database was searched for relevant articles from 1990 to 2015. Here we look at the various complications of RF ablation and also the methods to minimize them. This might increase the number of procedures performed. Evidence is emerging for the probable role of prophylactic ischemic scar ablation to prevent VT. Serious complications do occur during supraventricular tachycardia (SVT) ablations and knowledge of their incidence is important when deciding whether to proceed with ablation. In light of recent reports showing high incidence of silent cerebral infarcts and organized atrial arrhythmias following radiofrequency (RF) atrial fibrillation (AF) ablation, a review of its safety aspects is timely.
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