Author + information
- Received November 12, 2008
- Revision received January 6, 2009
- Accepted February 13, 2009
- Published online May 12, 2009.
- Riccardo Cappato, MD*,* (, )
- Hugh Calkins, MD†,
- Shih-Ann Chen, MD‡,
- Wyn Davies, MD§,
- Yoshito Iesaka, MD∥,
- Jonathan Kalman, MD¶,
- You-Ho Kim, MD#,
- George Klein, MD**,
- Andrea Natale, MD††,
- Douglas Packer, MD‡‡ and
- Allan Skanes, MD**
- ↵*Reprint requests and correspondence:
Dr. Riccardo Cappato, Arrhythmia and Electrophysiology Center, Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097 Milan, Italy
Objectives The purpose of this study was to provide a systematic multicenter survey on the incidence and causes of death occurring in the setting of or as a consequence of catheter ablation (CA) of atrial fibrillation (AF).
Background CA of AF is considered to be generally safe. However, serious complications, including death, have been reported.
Methods Using a retrospective case series, data relevant to the incidence and cause of intra- and post-procedural death occurring in patients undergoing CA of AF between 1995 and 2006 were collected from 162 of 546 identified centers worldwide.
Results Thirty-two deaths (0.98 per 1,000 patients) were reported during 45,115 procedures in 32,569 patients. Causes of deaths included tamponade in 8 patients (1 later than 30 days), stroke in 5 patients (2 later than 30 days), atrioesophageal fistula in 5 patients, and massive pneumonia in 2 patients. Myocardial infarction, intractable torsades de pointes, septicemia, sudden respiratory arrest, extrapericardial pulmonary vein (PV) perforation, occlusion of both lateral PVs, hemothorax, and anaphylaxis were reported to be responsible for 1 death each, while asphyxia from tracheal compression secondary to subclavian hematoma, intracranial bleeding, acute respiratory distress syndrome, and esophageal perforation from an intraoperative transesophageal echocardiographic probe were causes of 1 late death each.
Conclusions Death is a complication of CA of AF, occurring in 1 of 1,000 patients. Knowledge of possible precipitating causes is key to operators and needs to be considered during decision making with patients.
Dr. Cappato is a consultant and speaker for Biosense Webster and St. Jude Medical, a consultant for Bard, on the Advisory Board for St. Jude Medical, and has received research grants from Biosense Webster, St. Jude Medical, and Bard. Dr. Calkins is a consultant for Ablation Frontiers, Biosense Webster, and Boston Scientific, and has received stock options from Ablation Frontiers, fellowship and research support from Biosense Webster, and lecture support from St. Jude Medical. Dr. Davies is a consultant for Cryocath and Cyberheart. Dr. Kalman has received research grants and fellowship support from St. Jude Medical, Biosense Webster, and Medtronic Inc. Dr. Natale is a speaker for St. Jude Medical and Biosense Webster, and is on the Advisory Board of Biosense Webster, Stereotaxis, and St. Jude Medical. Dr. Packer is a speaker for Biosense Webster, Medtronic, and St. Jude Medical, a consultant for Biosense Webster and Boston Scientific, has received research contracts from Biosense Webster, and is on the Advisory Board of Siemens Medical. Dr. Skanes is on the Physician Advisory Board of and a speaker for Biosense Webster, and has received research grants from Biosense Webster.
- Received November 12, 2008.
- Revision received January 6, 2009.
- Accepted February 13, 2009.
- American College of Cardiology Foundation