Severe Periprocedural Complications After Ablation for Atrial Fibrillation: An International Collaborative Individual Patient Data Registry

Jeanne du Fay de Lavallaz, Patrick Badertscher, Michael Ghannam, Hakan Oral, Krit Jongnarangsin, Serge Boveda, Marta Madeira, Dhiraj Gupta, Wern Yew Ding, Rui Providencia, Edward MacLean, Michifumi Tokuda, Kenichi Tokutake, Tobias Reichlin, Fengxiang Zhang, Daniel Scherr, Miruna A. Popa, Henry Huang, Nikola Pavlović, Graham PeighXiaorong Li, Karapet Davtyan, Ioanna Kosmidou, Matteo Anselmino, Sandeep Jain, Fabien Squara, Eyal Nof, Mario Matta, Pipin Kojodjojo, Ziad Khoueiry, Sven Knecht, Philipp Krisai, Christian Sticherling, Michael Kühne*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Catheter ablation for atrial fibrillation (AF) including pulmonary vein isolation and possibly further substrate ablation is the most common electrophysiological procedure. Severe complications are uncommon, but their detailed assessment in a large worldwide cohort is lacking. Objectives: The aim of this study was to determine the incidence of periprocedural severe complications and to provide a detailed characterization of the diagnostic evaluation and management of these complications in patients undergoing AF ablation. Methods: Individual patient data were collected from 23 centers worldwide. Limited data were collected for all patients who underwent catheter ablation, and an expanded series of data points were collected for patients who experienced severe complications during periprocedural follow-up. Incidence, predictors, patient characteristics, management details, and overall outcomes of patients who experienced ablation-related complications were investigated. Results: Data were collected from 23 participating centers at which 33,879 procedures were performed (median age 63 years, 30% women, 71% radiofrequency ablations). The incidence of severe complications (n = 271) was low (tamponade 6.8‰, stroke 0.97‰, cardiac arrest 0.41‰, esophageal fistula 0.21‰, and death 0.21‰). Age, female sex, a dilated left atrium, procedure duration, and the use of radiofrequency energy were independently associated with the composite endpoint of all severe complications. Among patients experiencing tamponade, 13% required cardiac surgery. Ninety-three percent of patients with complications were discharged directly home after a median length of stay of 5 days (Q1-Q3: 3-7 days). Conclusions: This large worldwide collaborative study highlighted that tamponade, stroke, cardiac arrest, esophageal fistula, and death are rare after AF ablation. Older age, female sex, procedure duration, a dilated left atrium, and the use of radiofrequency energy were associated with severe complications in this multinational cohort. One in 8 patients with tamponade required cardiac surgery.

Original languageEnglish
JournalJACC: Clinical Electrophysiology
StateAccepted/In press - 2024
Externally publishedYes


FundersFunder number
Medizinische Universität Graz
Heart Rhythm Management Department
Clinique Pasteur, Toulouse, France)
Isabel Deisenhofer
University of California, San Diego
Technische Universität München
School of Medicine, Shanghai Jiao Tong University
Naval Medical Center San Diego


    • atrial fibrillation
    • cardiac arrest
    • catheter ablation
    • complications
    • esophageal fistula
    • incidence
    • predictors
    • pulmonary vein isolation
    • stroke
    • tamponade


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