Atrial fibrillation ablation complications

Decoding the evidence: A synopsis of indications and evidence for catheter ablation in atrial fibrillation (Review)

The present study reviews the role of catheter ablation (CA) in the management of atrial fibrillation (AF), a widespread arrhythmia associated with increased morbidity and mortality. The present review explores current indications and recent evidence supporting CA, assessing patient outcomes and identifying common complications associated with the procedure. Emphasis is placed on optimizing risk factors prior to ablation, including weight control and hypertension management, as these measures can significantly enhance post-procedural outcomes. The present review also discusses the use of antiarrhythmic and anticoagulant therapies following CA to minimize recurrence and reduce stroke risk. Additionally, the cost-effectiveness of CA is discussed, comparing its long-term economic impact with that of medical therapy alone. The present comprehensive review provides insight into best practices for AF management, supporting CA as a promising approach when integrated with targeted lifestyle modifications and pharmacological support for improved, patient-centered outcomes.

Three-dimensional catheter tip force sensing using multi-core fiber Bragg gratings

Awareness of catheter tip interaction forces is a crucial aspect during cardiac ablation procedures. The most important contact forces are the ones that originate between the catheter tip and the beating cardiac tissue. Clinical studies have shown that effective ablation occurs when contact forces are in the proximity of 0.2 N. Lower contact forces lead to ineffective ablation, while higher contact forces may result in complications such as cardiac perforation. Accurate and high resolution force sensing is therefore indispensable in such critical situations. Accordingly, this work presents the development of a unique and novel catheter tip force sensor utilizing a multi-core fiber with inscribed fiber Bragg gratings. A customizable helical compression spring is designed to serve as the flexural component relaying external forces to the multi-core fiber. The limited number of components, simple construction, and compact nature of the sensor makes it an appealing solution towards clinical translation. An elaborated approach is proposed for the design and dimensioning of the necessary sensor components. The approach also presents a unique method to decouple longitudinal and lateral force measurements. A force sensor prototype and a dedicated calibration setup are developed to experimentally validate the theoretical performance. Results show that the proposed force sensor exhibits 7.4 mN longitudinal resolution, 0.8 mN lateral resolution, 0.72 mN mean longitudinal error, 0.96 mN mean lateral error, a high repeatability, and excellent decoupling between longitudinal and lateral forces.

Iatrogenic Causes of Cardiac Tamponade Resulting From Surgical Procedures: An Overview

Cardiac tamponade is one of the most severely life-threatening emergencies encountered, mainly because of its significant impact on the pumping capacity of the heart by compressing the cardiac chambers due to the rapid accumulation of blood, fluid, pus, or clots in the pericardial sac. These accumulations may be collected following traumas, malignancies, uremia, and many other medical conditions as well as surgical procedures. Numerous errors and medicolegal aspects have been identified in diagnosing and treating cardiac tamponade associated with cardiac-related procedures such as valve replacement surgeries, cardiac pacemaker implantation, pericardiocentesis, and other non-cardiac related procedures such as peri-hiatal surgeries. Patients taking anticoagulants or anticancer medications are especially susceptible to developing cardiac tamponade when undergoing surgical procedures, raising the question of preoperative screening to avoid errors. Misdiagnosis, treatment delay or failure to deliver the utmost quality of treatment, lack of complication screening and follow-ups for those at risk, surgeons rushing to complete cases, burnout, and other human factors are predispositions to the development of cardiac tamponade. Fortunately, most of these errors occurring within healthcare settings are avoidable and must be prevented for eliminating any risks to reduce the incidence and mortality of cardiac tamponade cases resulting from iatrogenic etiology. It is an intricate condition where precision and caution are crucial.

Ultrasound-Guided Access Reduces Vascular Complications in Patients Undergoing Catheter Ablation for Cardiac Arrhythmias

Background: Femoral vascular access using the standard anatomic landmark-guided method is often limited by peripheral artery disease and obesity. We investigated the effect of ultrasound-guided vascular puncture (UGVP) on the rate of vascular complications in patients undergoing catheter ablation for atrial or ventricular arrhythmias. Methods: The data of 479 patients (59% male, mean age 68 years ± 11 years) undergoing catheter ablation for left atrial (n = 426; 89%), right atrial (n = 28; 6%) or ventricular arrhythmias (n = 28; 6%) were analyzed. All patients were on uninterrupted oral anticoagulants and heparin was administered intravenously during the procedure. Femoral access complications were compared between patients undergoing UGVP (n = 320; 67%) and patients undergoing a conventional approach (n = 159; 33%). Complication rates were also compared between patients with a BMI of >30 kg/m2 (n = 136) and patients with a BMI < 30 kg/m2 (n = 343). Results: Total vascular access complications including mild hematomas were n = 37 (7.7%). In the conventional group n = 17 (10.7%) and in the ultrasound (US) group n = 20 (6.3%) total vascular access complications occurred (OR 0.557, 95% CI 0.283−1.096). UGVP significantly reduced the risk of hematoma > 5 cm (OR 0.382, 95% CI 0.148, 0.988) or pseudoaneurysm (OR 0.160, 95% CI 0.032, 0.804). There was no significant difference between the groups regarding retroperitoneal hematomas or AV fistulas (p > 0.05). In patients with BMI > 30 kg/m2, UGVP led to a highly relevant reduction in the risk of total vascular access complications (OR 0.138, 95% CI 0.027, 0.659), hematomas > 5 cm (OR 0.051, 95% CI 0.000, 0.466) and pseudoaneurysms (OR 0.051, 95% CI 0.000, 0.466). Conclusion: UGVP significantly reduces vascular access complications. Patients with a BMI > 30 kg/m2 seem to particularly profit from a UGVP approach.

How To Follow Atrial Fibrillation Ablation Patients?

Catheter ablation is an established treatment option for symptomatic atrial fibrillation (AF), with circumferential pulmonary vein isolation being considered the cornerstone of the procedure. However, this is a complex intervention with potential major complications and with common arrhythmia recurrences. There is consensus among experts that all patients should be seen in follow-up regularly after AF ablation. To date there are limited data regarding the best methodology for routine clinical follow-up of this population. This review summarizes a contemporary insight into management of late complications following AF ablation, post-procedural anticoagulation and arrhythmia monitoring strategies, in order to prevent thromboembolic events, detect and treat arrhythmia recurrences, and discuss the use of upstream therapies after AF ablation.

Ablation to treat atrial fibrillation: beyond rhythm control

Care before, during, and after ablation is discussed in this article.

Electroanatomic mapping and radiofrequency ablation of porcine left atria and atrioventricular nodes using magnetic resonance catheter tracking

BACKGROUND

The MRI-compatible electrophysiology system previously used for MR-guided left ventricular electroanatomic mapping was enhanced with improved MR tracking, an MR-compatible radiofrequency ablation system and higher-resolution imaging sequences to enable mapping, ablation, and ablation monitoring in smaller cardiac structures. MR-tracked navigation was performed to the left atrium (LA) and atrioventricular (AV) node, followed by LA electroanatomic mapping and radiofrequency ablation of the pulmonary veins (PVs) and AV node.

METHODS AND RESULTS

One ventricular ablation, 7 PV ablations, 3 LA mappings, and 3 AV node ablations were conducted. Three MRI-compatible devices (ablation/mapping catheter, torqueable sheath, stimulation/pacing catheter) were used, each with 4 to 5 tracking microcoils. Transseptal puncture was performed under x-ray, with all other procedural steps performed in the MRI. Preacquired MRI roadmaps served for real-time catheter navigation. Simultaneous tracking of 3 devices was performed at 13 frames per second. LA mapping and PV radiofrequency ablation were performed using tracked ablation catheters and sheaths. Ablation points were registered and verified after ablation using 3D myocardial delayed enhancement and postmortem gross tissue examination. Complete LA electroanatomic mapping was achieved in 3 of 3 pigs, Right inferior PV circumferential ablation was achieved in 3 of 7 pigs, with incomplete isolation caused by limited catheter deflection. During AV node ablation, ventricular pacing was performed, 3 devices were simultaneously tracked, and intracardiac ECGs were displayed. 3D myocardial delayed enhancement visualized node injury 2 minutes after ablation. AV node block succeeded in 2 of 3 pigs, with 1 temporary block.

CONCLUSIONS

LA mapping, PV radiofrequency ablation, and AV node ablation were demonstrated under MRI guidance. Intraprocedural 3D myocardial delayed enhancement assessed lesion positional accuracy and dimensions.