Table 2

 Complications of catheter ablation

ComplicationIncidencew24How to minimise risk
LA, left atrium; PV, pulmonary vein.
Stroke/transient ischaemic attack1%• 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
Tamponade1.2%• 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 stenosis1.3%• 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 fistulaFew 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