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Complications of Radiofrequency Catheter Ablation and Prevention Methods

  • Andres C. Klein
  • Riccardo Proietti
  • Félix Ayala-ParedesEmail author
Chapter

Abstract

Radiofrequency catheter ablation (RFCA) of different arrhythmias carries inherent risks due to the nature of the tissue disruption obtained by heating the tip of the ablation catheter. Perforation of heart chambers and bleeding, thromboembolic complications, and complete AV block when ablating in the AV node-His area are the most feared. Most of these complications are related to the access, positioning of the catheters and radiofrequency itself and not to the imaging modality use to guide catheter navigation in the heart and the afferent or efferent vessels. We describe how to prevent and manage complications arising from the new paradigm of an EP lab working without fluoroscopy.

Keywords

Ablation Radiofrequency Complications Non-fluoro Less-fluoro Zero-fluoro Fluoroscopy reduction 3-D mapping 

References

  1. 1.
    Murakawa Y, Yamane T, Goya M, Inoue K, Naito S, Kumagai K, Miyauchi Y, Morita N, Nogami A, Shoda M, Okumura K, Hirao K, Japanese Heart Rhythm Society Members. Influence of substrate modification in catheter ablation of atrial fibrillation on the incidence of acute complications: analysis of 10 795 procedures in J-CARAF study 2011–2016. J Arrhythm. 2018;34(4):435–40.CrossRefGoogle Scholar
  2. 2.
    Latchamsetty R, Yokokawa M, Morady F, Kim HM, Mathew S, Tilz R, Kuck KH, Nagashima K, Tedrow U, Stevenson WG, Yu R, Tung R, Shivkumar K, Sarrazin JF, Arya A, Hindricks G, Vunnam R, Dickfeld T, Daoud EG, Oza NM, Bogun F. Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes. JACC Clin Electrophysiol. 2015;1(3):116–23.CrossRefGoogle Scholar
  3. 3.
    Wang JS, Shen YG, Yin RP, Thapa S, Peng YP, Ji KT, Liao LM, Lin JF, Xue YJ. The safety of catheter ablation for premature ventricular contractions in patients without structural heart disease. BMC Cardiovasc Disord. 2018;18(1):177.CrossRefGoogle Scholar
  4. 4.
    Ogunbayo GO, Charnigo R, Darrat Y, Shah J, Patel R, Suffredini J, Wilson W, Parrott K, Kusterer N, Biase LD, Natale A, Morales G, Elayi CS. Comparison of complications of catheter ablation for ventricular arrhythmias in adults with versus without structural heart disease. Am J Cardiol. 2018;122(8):1345–51.CrossRefGoogle Scholar
  5. 5.
    Dubin AM, Jorgensen NW, Radbill AE, Bradley DJ, Silva JN, Tsao S, Kanter RJ, Tanel RE, Trivedi B, Young ML, Pflaumer A, McCormack J, Seslar SP. What have we learned in the last 20 years? A comparison of a modern era pediatric and congenital catheter ablation registry to previous pediatric ablation registries. Heart Rhythm. 2019;16(1):57–63.  https://doi.org/10.1016/j.hrthm.2018.08.013. pii: S1547-5271(18)30800-2CrossRefPubMedGoogle Scholar
  6. 6.
    Hosseini SM, Rozen G, Saleh A, Vaid J, Biton Y, Moazzami K, Heist EK, Mansour MC, Kaadan MI, Vangel M, Ruskin JN. Catheter ablation for cardiac arrhythmias: utilization and in-hospital complications, 2000 to 2013. JACC Clin Electrophysiol. 2017;3(11):1240–8.CrossRefGoogle Scholar
  7. 7.
    Casella M, Dello Russo A, Pelargonio G, Del Greco M, Zingarini G, Piacenti M, Di Cori A, Casula V, Marini M, Pizzamiglio F, Zucchetti M, Riva S, Russo E, Narducci ML, Soldati E, Panchetti L, Startari U, Bencardino G, Perna F, Santangeli P, Di Biase L, Cichocki F, Fattore G, Bongiorni M, Picano E, Natale A, Tondo C. Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial. Europace. 2016;18(10):1565–72.CrossRefGoogle Scholar
  8. 8.
    Sommer P, Bertagnolli L, Kircher S, Arya A, Bollmann A, Richter S, Rolf S, Hindricks G. Safety profile of near-zero fluoroscopy atrial fibrillation ablation with non-fluoroscopic catheter visualization: experience from 1000 consecutive procedures. Europace. 2018;20(12):1952–8.CrossRefGoogle Scholar
  9. 9.
    Aytemir K, Canpolat U, Yorgun H, Evranos B, Kaya EB, Sahiner ML, Ozer N. Usefulness of ‘figure-of-eight’ suture to achieve haemostasis after removal of 15-French calibre femoral venous sheath in patients undergoing cryoablation. Europace. 2016;18:1545–50.CrossRefGoogle Scholar
  10. 10.
    Kottmaier M, Bourier F, Reents T, Reiter A, Kornmayer M, Semmler V, Telishevska M, Koch-Büttner K, Deiss M, Brooks S, Grebmer C, Lennerz C, Kolb C, Hessling G, Deisenhofer I. Safety and feasibility of subcutaneous purse-string suture of the femoral vein after electrophysiological procedures on uninterrupted oral anticoagulation. Am J Cardiol. 2017;119(11):1781–4.CrossRefGoogle Scholar
  11. 11.
    Calkins H, Willems S, Gerstenfeld EP, Verma A, Schilling R, Hohnloser SH, Okumura K, Serota H, Nordaby M, Guiver K, Biss B, Brouwer MA, Grimaldi M, RE-CIRCUIT Investigators. Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med. 2017;376(17):1627–36.CrossRefGoogle Scholar
  12. 12.
    Finlay M, Sawhney V, Schilling R, Thomas G, Duncan E, Hunter R, Virdi G, Abrams D, Sporton S, Dhinoja M, Earley M. Uninterrupted warfarin for periprocedural anticoagulation in catheter ablation of typical atrial flutter: a safe and cost-effective strategy. J Cardiovasc Electrophysiol. 2010;21(2):150–4.CrossRefGoogle Scholar
  13. 13.
    Chaumont J, Al Baridi E, Roux J-F, Badra M, Arseneau F, Ayala-Paredes F. His area is closer than expected to RF ablation lesions in AVNR Tachycardia. Abstract 612. CCS Congress. October 30, 2012. Toronto. Canada. Can J Cardiol. 2012;28(5):S327.CrossRefGoogle Scholar
  14. 14.
    Liao Z, Zhan X, Wu S. Successful radiofrequency ablation of a parahisian accessory pathway from the right coronary cusp. Int J Cardiol. 2015;186:41–2.CrossRefGoogle Scholar
  15. 15.
    Wells P, Dubuc M, Klein GJ, Dan D, Roux JF, et al. Intracardiac ablation for atrioventricular nodal re-entry tachycardia using a 6 mm distal electrode cryoablation catheter: prospective, multicenter, North American study (ICY-AVNRT). J Cardiovasc Electrophysiol. 2018;29(1):167–76.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Andres C. Klein
    • 1
    • 2
  • Riccardo Proietti
    • 3
  • Félix Ayala-Paredes
    • 2
    • 4
    Email author
  1. 1.Division of Cardiology (Arrhythmia Service)University of Ottawa Heart InstituteOttawaCanada
  2. 2.Canadian Working Group on Radiation Reduction in Arrhythmia ManagementTorontoCanada
  3. 3.University of PaduaPaduaItaly
  4. 4.Division of CardiologyCentre Hospitalier Universitaire de SherbrookeSherbrookeCanada

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