Document Detail

Outcomes after cardiac perforation during radiofrequency ablation of the atrium.
MedLine Citation:
PMID:  16302900     Owner:  NLM     Status:  MEDLINE    
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.
T Jared Bunch; Samuel J Asirvatham; Paul A Friedman; Kristi H Monahan; Thomas M Munger; Robert F Rea; Lawrence J Sinak; Douglas L Packer
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  16     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-23     Completed Date:  2006-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1172-9     Citation Subset:  IM    
Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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MeSH Terms
Atrial Fibrillation / surgery*
Catheter Ablation / adverse effects*
Heart Atria / injuries*
Heart Ventricles / injuries
Middle Aged
Pericardial Effusion / etiology,  ultrasonography
Statistics, Nonparametric
Tachycardia, Ectopic Atrial / surgery*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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