Background: Catheter ablation (CA), has gained wider acceptance as an attractive option for treating symptomatic AF. Although traditionally seen as a safe procedure, there is limited and conflicting data on procedure-related early morbimortality, with new evidence suggesting mortality may be as high as 0.5%-1%.
Objective: We aim to identify rates, trends and early morbimortality of post-atrial fibrillation (AF) ablation in high-volume centers.
Methods: Prospective registry of 2 high-volume ablation centers, comprising 3722 consecutive patients (mean age 61.1±11.2, 66.4% male, n=2471), who have undergone AF ablation from 2005 to 2019. Early mortality was defined as death during initial admission or 45-day readmission. The National Patient Registry was used for confirming deaths. Median follow-up time was 1954 days.
Results: Most patients were treated with radiofrequency (97%) while 3% were treated with cryoablation. Early mortality was 0.08% (n=3), with a median time from ablation to death of 22 days. Cumulative mortality at 3, 6 and 12 months were 0.08%, 0.16% and 0.19%, respectively. At 3 and 5 years, mortality remained low at 0.48% and 0.73%, respectively. Early mortality was higher among patients who had suffered procedural complications (fistula and stroke, p<0.001). Among the latter, pericardial effusion and tamponade were the most frequently found (0.6%, n=24), only 1 of which required emergent surgical drainage and myocardial repair. Early ischemic stroke was found in 2 patients (0.1%). Other less frequent complications were atrio-esophageal fistula (0.1%, n=2), phrenic nerve palsy (0.1%, n=2), anoxic encephalopathy following cardiac arrest (0.03%, n=1) and pulmonary vein stenosis (0.03%, n=1). Overall death on follow-up was significantly higher among patients with diabetes, peripheral and coronary artery disease and heart failure (p<0.05), mostly reflecting the burden of its comorbidities.
Conclusion: Our results show that early mortality following ablation is extremely low (<0.1%), considering a 3-month span, when performed by an experienced high-volume team. Early complications remain rare (<1%) and mostly uneventful, as our data casts further insight and reaffirms AF ablation safety.