Outcomes after cardiac perforation during radiofrequency ablation of the atrium

T. Jared Bunch, Samuel J Asirvatham, Paul Andrew Friedman, Kristi H. Monahan, Thomas M. Munger, Robert F. Rea, Lawrence J. Sinak, Douglas L Packer

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

Background: Perforation during catheter procedures in either the atrium or ventricle is relatively uncommon, but potentially fatal if tamponade ensues. This study analyzes the occurrence and outcomes of cardiac perforation during catheter-based radiofrequency ablation procedures in the left atrium. Methods: All patients with a periprocedure perforation who have undergone radiofrequency ablation for atrial fibrillation (AF) or tachycardia were included. Results: Of 632 procedures performed from January 1999 to October 2004, 15 (2.4%) were complicated by perforation requiring pericardiocentesis. The perforation site was left atrium in 9 (60.0%), right atrium in 1 (6.7%), and right ventricle in 5 (33.3%). Intracardiac echocardiography was used in 13 (86.7%) and revealed an effusion before overt instability in 11 (73.3%). Thirteen (86.7%) patients developed a blood pressure <60 mmHg. The pressure stabilized in all patients after pericardiocentesis (hypotension to intervention: 10.1 ± 5.1 minutes). The total blood volume removed was 848 ± 880 mL (left atrium/right atrium: 1,074 ± 1,002 vs right ventricle: 396 ± 266, P = 0.168). Two patients required surgery to close left atrium dome perforations. The ablation was completed in 7 (46.7%) patients. Ten (66.7%) later developed early reoccurrence of AF. All patients were neurologically intact at hospital discharge. During a 1.5 ± 1.1 year follow-up, AF was eliminated (n = 4) or controlled (n = 1) in 5 (71.4%) patients with complete procedures, and 2 (20.0%) patients underwent successful repeat ablation. Conclusion: The incidence of perforation during ablation of the left atrium is low. Most perforations occur in the left atrium; however, few require surgical closure. Although less than with uncomplicated procedures, the majority of patients with complete ablations achieve long-term elimination of AF.

Original languageEnglish (US)
Pages (from-to)1172-1179
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume16
Issue number11
DOIs
StatePublished - Nov 2005

Fingerprint

Heart Atria
Atrial Fibrillation
Pericardiocentesis
Heart Ventricles
Catheter Ablation
Blood Volume
Tachycardia
Hypotension
Echocardiography
Catheters
Blood Pressure
Pressure
Incidence

Keywords

  • Ablation
  • Arrhythmia
  • Atrium
  • Fibrillation
  • Myocardium

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes after cardiac perforation during radiofrequency ablation of the atrium. / Bunch, T. Jared; Asirvatham, Samuel J; Friedman, Paul Andrew; Monahan, Kristi H.; Munger, Thomas M.; Rea, Robert F.; Sinak, Lawrence J.; Packer, Douglas L.

In: Journal of Cardiovascular Electrophysiology, Vol. 16, No. 11, 11.2005, p. 1172-1179.

Research output: Contribution to journalArticle

Bunch, T. Jared ; Asirvatham, Samuel J ; Friedman, Paul Andrew ; Monahan, Kristi H. ; Munger, Thomas M. ; Rea, Robert F. ; Sinak, Lawrence J. ; Packer, Douglas L. / Outcomes after cardiac perforation during radiofrequency ablation of the atrium. In: Journal of Cardiovascular Electrophysiology. 2005 ; Vol. 16, No. 11. pp. 1172-1179.
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abstract = "Background: Perforation during catheter procedures in either the atrium or ventricle is relatively uncommon, but potentially fatal if tamponade ensues. This study analyzes the occurrence and outcomes of cardiac perforation during catheter-based radiofrequency ablation procedures in the left atrium. Methods: All patients with a periprocedure perforation who have undergone radiofrequency ablation for atrial fibrillation (AF) or tachycardia were included. Results: Of 632 procedures performed from January 1999 to October 2004, 15 (2.4{\%}) were complicated by perforation requiring pericardiocentesis. The perforation site was left atrium in 9 (60.0{\%}), right atrium in 1 (6.7{\%}), and right ventricle in 5 (33.3{\%}). Intracardiac echocardiography was used in 13 (86.7{\%}) and revealed an effusion before overt instability in 11 (73.3{\%}). Thirteen (86.7{\%}) patients developed a blood pressure <60 mmHg. The pressure stabilized in all patients after pericardiocentesis (hypotension to intervention: 10.1 ± 5.1 minutes). The total blood volume removed was 848 ± 880 mL (left atrium/right atrium: 1,074 ± 1,002 vs right ventricle: 396 ± 266, P = 0.168). Two patients required surgery to close left atrium dome perforations. The ablation was completed in 7 (46.7{\%}) patients. Ten (66.7{\%}) later developed early reoccurrence of AF. All patients were neurologically intact at hospital discharge. During a 1.5 ± 1.1 year follow-up, AF was eliminated (n = 4) or controlled (n = 1) in 5 (71.4{\%}) patients with complete procedures, and 2 (20.0{\%}) patients underwent successful repeat ablation. Conclusion: The incidence of perforation during ablation of the left atrium is low. Most perforations occur in the left atrium; however, few require surgical closure. Although less than with uncomplicated procedures, the majority of patients with complete ablations achieve long-term elimination of AF.",
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T1 - Outcomes after cardiac perforation during radiofrequency ablation of the atrium

AU - Bunch, T. Jared

AU - Asirvatham, Samuel J

AU - Friedman, Paul Andrew

AU - Monahan, Kristi H.

AU - Munger, Thomas M.

AU - Rea, Robert F.

AU - Sinak, Lawrence J.

AU - Packer, Douglas L

PY - 2005/11

Y1 - 2005/11

N2 - Background: Perforation during catheter procedures in either the atrium or ventricle is relatively uncommon, but potentially fatal if tamponade ensues. This study analyzes the occurrence and outcomes of cardiac perforation during catheter-based radiofrequency ablation procedures in the left atrium. Methods: All patients with a periprocedure perforation who have undergone radiofrequency ablation for atrial fibrillation (AF) or tachycardia were included. Results: Of 632 procedures performed from January 1999 to October 2004, 15 (2.4%) were complicated by perforation requiring pericardiocentesis. The perforation site was left atrium in 9 (60.0%), right atrium in 1 (6.7%), and right ventricle in 5 (33.3%). Intracardiac echocardiography was used in 13 (86.7%) and revealed an effusion before overt instability in 11 (73.3%). Thirteen (86.7%) patients developed a blood pressure <60 mmHg. The pressure stabilized in all patients after pericardiocentesis (hypotension to intervention: 10.1 ± 5.1 minutes). The total blood volume removed was 848 ± 880 mL (left atrium/right atrium: 1,074 ± 1,002 vs right ventricle: 396 ± 266, P = 0.168). Two patients required surgery to close left atrium dome perforations. The ablation was completed in 7 (46.7%) patients. Ten (66.7%) later developed early reoccurrence of AF. All patients were neurologically intact at hospital discharge. During a 1.5 ± 1.1 year follow-up, AF was eliminated (n = 4) or controlled (n = 1) in 5 (71.4%) patients with complete procedures, and 2 (20.0%) patients underwent successful repeat ablation. Conclusion: The incidence of perforation during ablation of the left atrium is low. Most perforations occur in the left atrium; however, few require surgical closure. Although less than with uncomplicated procedures, the majority of patients with complete ablations achieve long-term elimination of AF.

AB - Background: Perforation during catheter procedures in either the atrium or ventricle is relatively uncommon, but potentially fatal if tamponade ensues. This study analyzes the occurrence and outcomes of cardiac perforation during catheter-based radiofrequency ablation procedures in the left atrium. Methods: All patients with a periprocedure perforation who have undergone radiofrequency ablation for atrial fibrillation (AF) or tachycardia were included. Results: Of 632 procedures performed from January 1999 to October 2004, 15 (2.4%) were complicated by perforation requiring pericardiocentesis. The perforation site was left atrium in 9 (60.0%), right atrium in 1 (6.7%), and right ventricle in 5 (33.3%). Intracardiac echocardiography was used in 13 (86.7%) and revealed an effusion before overt instability in 11 (73.3%). Thirteen (86.7%) patients developed a blood pressure <60 mmHg. The pressure stabilized in all patients after pericardiocentesis (hypotension to intervention: 10.1 ± 5.1 minutes). The total blood volume removed was 848 ± 880 mL (left atrium/right atrium: 1,074 ± 1,002 vs right ventricle: 396 ± 266, P = 0.168). Two patients required surgery to close left atrium dome perforations. The ablation was completed in 7 (46.7%) patients. Ten (66.7%) later developed early reoccurrence of AF. All patients were neurologically intact at hospital discharge. During a 1.5 ± 1.1 year follow-up, AF was eliminated (n = 4) or controlled (n = 1) in 5 (71.4%) patients with complete procedures, and 2 (20.0%) patients underwent successful repeat ablation. Conclusion: The incidence of perforation during ablation of the left atrium is low. Most perforations occur in the left atrium; however, few require surgical closure. Although less than with uncomplicated procedures, the majority of patients with complete ablations achieve long-term elimination of AF.

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KW - Arrhythmia

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KW - Fibrillation

KW - Myocardium

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