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Influence of ablation index on the incidence of cardiac tamponade complicating pulmonary vein isolation

Einfluss des Ablationsindex auf die Inzidenz der Herztamponade als Komplikation der Pulmonalvenenisolation

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Abstract

Background

Cardiac tamponade (CT) complicating pulmonary vein isolation (PVI) for atrial fibrillation (AF) is a complication that can increase morbidity and mortality. Radiofrequency energy is a known cause of CT. Ablation Index (AI) is a novel ablation quality marker. We hypothesized that use of AI reduces the incidence of CT.

Methods

All AF procedures between 10/2014 and 06/2019 were included. Three ablation groups were defined: group A, RF ablation with non-contact force (CF) catheter; group B, RF ablation with CF catheter; and group C, RF ablation with CF catheter using AI. All episodes of CT were analyzed.

Results

In total, 1222 consecutive AF patients underwent PVI. Group A consisted of 100 (8%) procedures, while group B included 432 (35%) procedures and group C 690 (57%) procedures. The overall risk for CT in all patients was 2.1% (26/1222). The risk in group A was 2.9% (3/100), in group B 2.5% (11/432), and in group C 1.7% (12/690), including all 1222 patients in the analysis (p < 0.05). Univariate analysis identified no further specific predictors for CT. With the exception of one patient (1/26; 3.8%), who needed surgical treatment, all CT could be successfully drained.

Conclusions

In a high-volume center, the use of AI decreased the risk of CT in patients undergoing RF ablation for AF by 32%.

Zusammenfassung

Hintergrund

Die Herztamponade (HT) als Komplikation der Pulmonalvenenisolation (PVI) bei Vorhofflimmern (VHF) kann Morbidität und Mortalität erhöhen. Radiofrequenz(RF)-Energie stellt eine bekannte Ursache der HT dar. Der Ablationsindex (AI) ist ein neuer Qualitätsindikator der Ablation. Im vorliegenden Beitrag wird untersucht, ob die Anwendung des AI die HT-Inzidenz senkt.

Methoden

Alle PVI zwischen 10/2014 und 6/2019 wurden eingeschlossen. Drei Ablationsgruppen wurden definiert: Gruppe A, RF-Ablation mit Katheter ohne Messung des Anpressdrucks („contact force“ [CF]); Gruppe B, RF-Ablation mit CF-Katheter; Gruppe C, RF-Ablation mit CF-Katheter und Anwendung des AI. Alle HT-Ereignisse wurden analysiert.

Ergebnisse

Insgesamt 1222 konsekutive Patienten mit VHF wurden einer PVI unterzogen. Gruppe A umfasste 100 (8%) Eingriffe, Gruppe B 432 (35%) und Gruppe C 690 (57%). Das Gesamtrisiko einer HT bei allen Patienten betrug 2,1% (26/1222). Das Risiko in Gruppe A lag bei 2,9% (3/100), in Gruppe B bei 2,5% (11/432) und in Gruppe C bei 1,7% (12/690), wobei alle 1222 Patienten in die Analyse eingingen (p < 0,05). Die univariate Analyse ergab keine weiteren spezifischen Prädiktoren für HT. Mit Ausnahme eines Patienten (1/26; 3,8%), der operativ versorgt werden musste, konnten alle HT erfolgreich drainiert werden.

Schlussfolgerungen

In einem Zentrum mit hohem Patientenaufkommen senkte die Anwendung des AI das HT-Risiko bei Patienten mit VHF, die einer RF-Ablation unterzogen wurden, um 32%.

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Authors and Affiliations

  1. Department of Electrophysiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Straße 21, 45131, Essen, Germany

    Nico Reinsch MD, FESC, Anna Füting MD, Ute Ruprecht MD & Kars Neven MD, PhD, FEHRA

  2. Witten/Herdecke University, Witten, Germany

    Nico Reinsch MD, FESC, Anna Füting MD, Ute Ruprecht MD & Kars Neven MD, PhD, FEHRA

  3. Department of Cardiology, Evangelisches Krankenhaus Oberhausen, Oberhausen, Germany

    Jochen Buchholz MD

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  1. Nico Reinsch MD, FESC
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  2. Anna Füting MD
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  3. Jochen Buchholz MD
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  4. Ute Ruprecht MD
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  5. Kars Neven MD, PhD, FEHRA
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Correspondence to Nico Reinsch MD, FESC.

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Conflict of interest

N. Reinsch, A. Füting, and J. Buchholz declare that they have no competing interests. U. Ruprecht is a consultant for Biosense Webster. K. Neven received speaker fees from Biosense Webster.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements.

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Reinsch, N., Füting, A., Buchholz, J. et al. Influence of ablation index on the incidence of cardiac tamponade complicating pulmonary vein isolation. Herz 46 (Suppl 2), 228–234 (2021). https://doi.org/10.1007/s00059-020-04988-y

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  • DOI: https://doi.org/10.1007/s00059-020-04988-y

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