Complications of catheter ablation
| Complication | Incidencew24 | How to minimise risk |
|---|---|---|
| LA, left atrium; PV, pulmonary vein. | ||
| Stroke/transient ischaemic attack | 1% | • Warfarin substituted for clexane during perioperative period |
| • Preoperative transoesophageal echocardiography | ||
| • Heparin infusion to maintain activated clotting time >300 s throughout case | ||
| • Heparin–saline irrigated ablation catheters | ||
| • Transseptal sheaths in right side of heart when possible | ||
| • Fastidious technique when removing/exchanging catheters | ||
| Tamponade | 1.2% | • Competency in transseptal puncture |
| • Intracardiac echo to monitor microbubbles and venting (indicating potential cavitation of lesion) | ||
| • Competency in emergency pericardial aspiration | ||
| • Rapid access to cardiothoracic surgical assistance | ||
| >50% pulmonary vein stenosis | 1.3% | • Ablation on atrial aspect of LA-PV junction or outside vein |
| • Low power (20–30 W) radiofrequency ablation near PV | ||
| • Cryoablation causes less PV stenosis but longer procedure | ||
| • Symptoms non-specific—therefore need low suspicion to investigate | ||
| Atrio-oesophageal fistula | Few cases worldwide | • Where possible avoid lesions in posterior LA |
| • Reduced power (20–30 W) if ablating at posterior LA | ||
| • Fluoroscopic location of oesophagus using probe | ||