Nakhla Michael, Ahmed Mahmoud Samy, Bishara Rafik, Iskandar Odette, Raju Arvind Kumar Venkataramana, Frishman William H, Aronow Wilbert S
From the Department of Medicine, Saint Vincent Hospital, Worcester, MA.
Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY.
Cardiol Rev. 2024 Dec 31. doi: 10.1097/CRD.0000000000000842.
The number of atrial catheter ablation procedures has significantly increased in recent years, becoming a first-line treatment modality for various supraventricular tachycardias due to their safety and efficacy. Complications, ranging from mild to life-threatening, can arise during different stages of the procedure, including vascular access complications (eg, hematoma or vascular fistula formation, retroperitoneal bleeding, etc.), thromboembolic complications (eg, stroke, transient ischemic attack, air embolism, etc.), mechanical complications (eg, cardiac perforation and tamponade), as well as pulmonary vein stenosis, atrio-esophageal fistulas, phrenic nerve injury, and gastroparesis. Atrial fibrillation ablation procedures, in particular, carry a higher complication rate due to their complexity. This review discusses the incidence, mechanisms, diagnosis, management, and prevention of these complications. Key strategies to reduce risks include optimized anticoagulation protocols, the use of intracardiac echocardiography, reduced energy delivery, and esophageal temperature monitoring, among others. Timely detection and intervention, especially in the case of life-threatening complications, is crucial. Pulsed-field ablation, a novel technique using nonthermal electrical energy, offers a promising and precise alternative to conventional thermal ablation with a favorable safety profile. However, further research is needed to fully understand its complications and refine management strategies.
近年来，心房导管消融手术的数量显著增加，由于其安全性和有效性，已成为各种室上性心动过速的一线治疗方式。在手术的不同阶段可能会出现各种并发症，从轻到危及生命不等，包括血管穿刺并发症（如血肿或血管瘘形成、腹膜后出血等）、血栓栓塞并发症（如中风、短暂性脑缺血发作、空气栓塞等）、机械并发症（如心脏穿孔和心包填塞），以及肺静脉狭窄、心房食管瘘、膈神经损伤和胃轻瘫。特别是心房颤动消融手术，由于其复杂性，并发症发生率较高。本文综述了这些并发症的发生率、机制、诊断、处理和预防。降低风险的关键策略包括优化抗凝方案、使用心内超声心动图、减少能量传递以及食管温度监测等。及时检测和干预，尤其是在危及生命的并发症情况下，至关重要。脉冲场消融是一种使用非热能的新技术，与传统热消融相比，具有良好的安全性，提供了一种有前景且精确的替代方法。然而，需要进一步研究以充分了解其并发症并完善管理策略。
