MEDICAL PROFESSIONALS

Therapy Outcomes

Radiofrequency catheter ablation is considered safe

As with all medical procedures, catheter ablation has been highly scrutinized with regards to safety. In a worldwide survey on the technique, low complications rates in the range of 1-3% have been reported, depending on the centre (ref. 18).

Complication rates of common surgical procedures

Table: Bar graph showing most frequent complications associated with CA

The more frequently observed complications include transient ischaemic attack, pulmonary vein stenosis, and cardiac tamponade; certainly the most talked about complication has been atrioesophageal fistula, even though only an extremely small number of cases have been reported (0.05%). The periprocedural death rate is extremely low and only four deaths were reported in nearly 10,000 procedures (ref. 18). Furthermore, these frequencies were compiled before the advent of newer imaging techniques and irrigated catheters, which provide improved navigation and control of ablation parameters, which should further improve the efficacy and risk/benefit profile of the procedure.

Figure: Major complications with pulmonary vein ablation in 1049 patients (7 series). Adapted from Packer et al.

Although the procedure is still being refined, there is growing harmonization on ablation strategies that focus on isolation of the pulmonary veins as the mainstay for treatment of paroxysmal Afib. Further consensus on ablation techniques will allow more precise figures to be obtained on the safety profile of catheter ablation. In the meantime, the complication rate of catheter ablation is comparative to other routine, low-risk procedures such as tubal ligation.

Catheter ablation as an important therapeutic mainstay

The recent successes of catheter ablation and overall low complication rates, accompanied by the failure rates of standard medical treatments, have prompted some to advocate that catheter ablation should be offered at an early stage in highly selected patients, such as those with paroxysmal or chronic Afib with insignificant or moderate structural heart disease, (ref. 30). The role for catheter ablation in the treatment of Afib is certainly increasing, based on the number of procedures being carried out each year, although these are still often concentrated in high-volume centers with extensive experience. It has recently been recommended that catheter ablation be considered for appropriate patients after failure of one AAD in the newly updated Guidelines for management of Afib (ref. 31).