Complications arising from catheter ablation of atrial fibrillation: Temporal trends and predictors

Background: The reported complication rate of catheter ablation of atrial fibrillation (AF) varies. Objective: Our goal was to assess temporal trends and the effect of both institutional and individual operators' experience on the incidence of complications. Methods: All patients undergoing AF ablation at Johns Hopkins Hospital between February 2001 and December 2010 were prospectively enrolled in a database. Major complications were defined as those that were life-threatening, resulted in permanent harm, required intervention, or significantly prolonged hospitalization. Results: Fifty-six major complications occurred in 1190 procedures (4.7%). The majority of complications were vascular (18; 1.5%), followed by pericardial tamponade (13; 1.1%) and cerebrovascular accident (12; 1.1%). No cases of death or atrioesophageal fistula occurred. The overall complication rate decreased from 11.1% in 2002 to 1.6% in 2010 (P <.05). On univariate analysis, demographic and clinical factors associated with the increased risk of complications were CHADS ₂ score of <2 (hazard ratio [HR] = 2.5; 95% confidence interval [CI] = 1.44.4; P =.002), female gender (HR = 2.0; 95% CI = 1.23.5; P =.014), and age (HR = 1.03; 95% CI = 1.01.1; P =.042). Gender and CHADS ₂ score of <2 remained independent predictors of complication on multivariable analysis. Conclusion: The complication rate of catheter ablation of AF decreased with increased institutional experience. Female gender and CHADS ₂ score of <2 are significant independent risk factors for complications and should be considered when referring patients for AF ablation.