Table 14

Complications of Radiofrequency Catheter Ablation for AF

ComplicationSymptoms/SignsTreatment
Air embolismAcute ischemia, cardiac arrest, AV block, hypotensionSupplemental oxygen, fluids, CPR, or pacing if indicated
Atrial-esophageal fistulaUsually 1–4 wk after ablation, dysphagia, unexplained fever, chills, sepsis, neurological events (septic emboli)CT or MRI of esophagus, avoiding endoscopy, immediate surgical correction
Cardiac tamponade/perforationAbrupt or gradual fall in BPPericardiocentesis, emergent surgical drainage if pericardiocentesis fails
Phrenic nerve injury resulting in diaphragmatic paralysisShortness of breath, elevated hemidiaphragmNone; usually resolves spontaneously
Iatrogenic atrial flutterTachycardiaCardioversion, antiarrhythmic drugs, or repeat ablation
Gastric motility disorderNausea, vomiting, bloating, abdominal painDepends on severity of symptoms
Mitral valve injury requiring surgeryEntrapment of catheterAdvance sheath with gentle catheter retraction, surgical removal
MIChest pain, ST changes, hypotensionStandard therapy
PericarditisChest pain, typical qualityNSAIDs, colchicine, steroids
Pulmonary vein stenosisShortness of breath, cough, hemoptysisPV dilation/stent or no therapy
Radiation injuryPain and reddening at radiation site; can present lateTreat as burn injury
Stroke or TIANeurological deficitConsider lysis therapy
Vascular access complications
  • Femoral pseudoaneurysm

Pain or pulsatile mass at groinObservation, compression, thrombin injection, possible surgery
  • Arteriovenous fistula

Pain, bruit at groin siteObservation, compression, possible surgery
  • Hematoma

Pain, swellingCompression
DeathN/AN/A

AF indicates atrial fibrillation; AV, atrioventricular; BP, blood pressure; CPR, cardiopulmonary resuscitation; CT, computed tomography; MI, myocardial infarction; MRI, magnetic resonance imaging; N/A, not applicable; NSAIDs, nonsteroidal anti-inflammatory drugs; PV, pulmonary valve; and TIA, transient ischemic attack.