ABLATION FOR ATRIAL FIBRILLATION: NOT RISK FREE

The risk for death after AF ablation is 1 in 1000 patients or 1 in 1385 procedures.

Catheter ablation is an accepted procedure for patients with atrial fibrillation in whom medical treatment is ineffective. Currently, the only indication for AF ablation is impaired quality of life (QOL); ablation is not recommended for patients without symptoms who merely wish to stop taking warfarin. Individuals with AF have an increased mortality risk, and no AF treatment, including ablation, has been shown to reduce that risk. The AF ablation procedure itself carries a variety of risks. However, the incidence of death from complications of AF ablation has not been determined, because the data are from single-center or small multicenter trials.

In this international survey of 162 centers, published in Journal Watch Cardiology May 27, 2009-32,569 patients underwent 45,115 AF ablation procedures. In all, 32 deaths occurred (0.98 per 1000 patients; 0.71 per 1000 procedures), including 7 from tamponade, 5 from atrioesophageal fistula, and 3 from stroke.

Comment by a cardiologist: These data provide useful guidance to physicians and patients regarding the risks of AF ablation. Whether a 1-in-1385 procedural mortality risk is justified by potentially improved QOL is an individual patient decision. However, to put this risk in perspective, it is roughly the equivalent of the risk of knee replacement
— another invasive QOL-improving procedure — and it is much lower than the risk of elective coronary percutaneous interventions, arguably also performed largely to improve QOL.

CITATION:
Cappato R et al. Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol 2009 May 12; 53:1798.

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