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Catheter Ablation In Atrial Fibrillation: Comorbidities And Mortality From High-volume Centers
Session:
Painel 4 - Arritmologia 5
Speaker:
Joao Adriano Sousa
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.2 Atrial Fibrillation - Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Joao Adriano Sousa; João Carmo; Daniel Nascimento Matos; Gustavo Da Rocha Rodrigues; António Ferreira; José Alencar; Fábio Klemtz; Anai Durazzo; Maria Salomé Carvalho; Francisco Moscoso Costa; Pedro Lopes Do Carmo; Leonor Parreira; Francisco Bello Morgado; Diogo Cavaco; Pedro Adragão
Abstract
<p><strong>Background:</strong> 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 early mortality may be as high as 0.5%-1%.</p> <p><strong>Objective:</strong> We aimed to assess the rates of early and late morbimortality of post-atrial fibrillation (AF) ablation in high-volume centers.</p> <p><strong>Methods:</strong> Prospective registry of 2 high-volume ablation centers, comprising <strong>3722 </strong>consecutive patients (mean age 61.1±11.2, 66.4% male, n=2471), who underwent AF ablation from <u>2005 to 2019</u>. Early mortality was defined as death during initial admission or during the first 45 days after ablation. Median follow-up time was 5.4 years.</p> <p><strong>Results:</strong> 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 was 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 occurred 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). </p> <p><strong>Conclusion:</strong> Early mortality following ablation is very low (<0.1%), when performed by an experienced high-volume team. Severe complications are rare (<1%) and mostly amenable to treatment. Our findings challenge recent evidence and reaffirm the overall safety of AF ablation.</p>
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