Sydell and Arnold Miller Family Heart and Vascular Institute, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
JACC Clin Electrophysiol. 2019 Mar;5(3):284-291. doi: 10.1016/j.jacep.2018.11.013. Epub 2019 Jan 30.
This study sought to assess the incidence and outcomes of life-threatening complications from atrial fibrillation ablations in a high volume center.
With increasing rates of atrial fibrillation ablation procedures, an increase in life-threatening procedure-related complications has been reported despite improvements in technology and ablation strategies.
Between 2000 and 2015, 10,378 patients underwent atrial fibrillation ablation at our institution and were enrolled in a prospectively maintained data registry. We identified all patients who had life-threatening cardiac, neurological, respiratory, or vascular complications to the ablation resulting in death or requiring emergent intervention.
Major life-threatening complications occurred in 100 patients (0.9%). The most common was pericardial effusion requiring pericardiocentesis (0.5%), with 7 (0.07%) requiring emergent surgical repair for cardiac perforation. Stroke occurred in 27 patients (0.3%) with a vast majority having an ischemic stroke (93%) followed by hemorrhagic (3.5%) and ischemic stroke with hemorrhagic conversion (3.5%). The yearly incidence of stroke decreased from an average of 1.1% per year in the first tertile (2000 to 2004) to 0.2% per year in the last 2 tertiles (2005 to 2015). Permanent neurological deficits occurred in 23 patients. Vascular complications causing hemorrhagic shock occurred in 7 patients (0.06%), 5 of whom required urgent surgical intervention. Acute coronary syndrome requiring urgent percutaneous coronary revascularization occurred in 2 patients whereas 1 developed a right coronary artery air embolus. No procedural death or atrio-esophageal fistulae occurred.
In a large quaternary care center, the incidence of life-threatening complications is low. Experienced operators, high volume, continuous quality improvement initiatives, and efficient back-up support have allowed exemplary safety profiles and 0 procedure-related deaths over 16 years.
本研究旨在评估在高容量中心行房颤消融术的致死性并发症发生率及结局。
尽管技术和消融策略不断改进，但随着房颤消融术的应用率不断增加，与手术相关的致死性并发症发生率也有所增加。
在本机构，2000 年至 2015 年间共有 10378 例行房颤消融术的患者被纳入前瞻性维护的数据登记。我们识别出所有因消融术导致的致死性心脏、神经、呼吸或血管并发症的患者，这些并发症需要紧急介入治疗。
100 例（0.9%）患者发生重大致死性并发症。最常见的并发症是心包积液，需要行心包穿刺引流（0.5%），其中 7 例（0.07%）因心脏穿孔而行紧急手术修补。27 例（0.3%）患者发生卒中，其中绝大多数为缺血性卒中（93%），其次为出血性卒中（3.5%）和缺血性卒中伴出血性转化（3.5%）。卒中的年发生率从第 1 三分位（2000 年至 2004 年）的平均每年 1.1%降至第 2 及 3 三分位（2005 年至 2015 年）的每年 0.2%。23 例患者发生永久性神经功能缺损。7 例（0.06%）患者发生导致出血性休克的血管并发症，其中 5 例需要紧急外科干预。2 例患者发生需要紧急经皮冠状动脉血运重建的急性冠状动脉综合征，1 例发生右冠状动脉空气栓塞。无手术相关死亡或发生食管-心房瘘。
在一个大型的四级医疗中心，致死性并发症的发生率较低。经验丰富的术者、高手术量、持续质量改进措施以及高效的后备支持使得该中心在 16 年中保持了卓越的安全性，无手术相关死亡。
