ABSTRACT
<p><b>OBJECTIVE</b>Pericardial effusion (PE) is a major complication of atrial fibrillation ablation (AFB). We analyzed the incidence, risk factors and managements of PE post AFB (radiofrequency catheter ablation).</p><p><b>METHODS</b>A total of 156 consecutive patients with AF [male 108, paroxysmal AF 114, (57.6 +/- 11.3) years], who underwent AFB guided by a three-dimensional mapping system (CARTO or CARTO-Merge, Biosense-Webster Inc., Diamond Bar, California) and a circular mapping catheter (Lasso, Biosense-Webster Inc., Diamond Bar, California), were included in this study. The ablation strategy included circumferential pulmonary veins isolation (CPVI), linear ablation and/or complex fractionated atrial electrograms (CFAEs) ablation. Electrophysiological data and vital signs of patients were recorded by a multiple physiological recorder (Prucka, GE Medical Systems) during ablation. Ablation process, sites, duration and other related factors were also recorded. Echocardiography and other examinations were performed for diagnosing and monitoring PE.</p><p><b>RESULTS</b>CPVI were achieved in all 156 patients. Incidence of PE was 10.3% (16/156) post AFB. One patient developed acute cardiac tamponade and emergency drainage of the pericardial effusion was performed through a median sternotomy and patient recovered without complications during the 18 months follow-up. The rest 15 PE patients with small PE received outpatient care and no invasive treatment was needed and PE disappeared after 3 months in 6 patients and after 6 months in 9 patients. Univariate analysis showed that the composition of gender (P < 0.01), ablation in coronary sinus (CS, P = 0.026), ablation of CFAEs (P = 0.037) and superior vena cava (SVC, P = 0.041) were risk factors for PE. Logistic regression analysis showed that female gender [beta = 3.594, exp (b) = 36.4, 95% confidence interval (CI): 4.2 - 312.1, P = 0.001] and ablation in CS [beta = 2.419, exp (b) = 11.2, 95% CI: 1.0 - 124.6, P = 0.049] were independent risk factors for PE post AFB.</p><p><b>CONCLUSIONS</b>PE is a common complication of AFB, female gender and ablation in CS were independent risk factors for PE. Most PE patients experienced spontaneous recovery but emergency treatment was needed for patient with cardiac tamponade.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Atrial Fibrillation , Therapeutics , Catheter Ablation , Follow-Up Studies , Incidence , Pericardial Effusion , Therapeutics , Risk FactorsABSTRACT
<p><b>BACKGROUND</b>Pulmonary-vein isolation (PVI) is currently used for the treatment of chronic and paroxysmal atrial fibrillation and a major risk of PVI is thromboembolism. The purpose of this study was to observe embolic event rate in patients with persistent or paroxysmal atrial fibrillation (AF) undergone PVI.</p><p><b>METHODS</b>Circumferential PVI (CPVI) was performed in 64 consecutive patients with persistent AF (42 men, aged (60.0 +/- 9.1) years) and in 84 consecutive patients with paroxysmal AF (53 men, aged (61.4 +/- 9.3) years). Warfarin was administrated in all patients before ablation for at least 3 weeks ((5.2 +/- 2.6) weeks) and continued for at least 3 months post ablation with international normalized ratio (INR) of 2.0 - 3.0. During CPVI, intravenous heparin was given at a dose of 5000 - 8000 U or 75 - 100 U/kg, followed by 1000 U or 12 U/kg per hour.</p><p><b>RESULTS</b>In patients with persistent AF, 1 patient developed embolic event during ablation and 3 patients developed embolic events after ablation. In contrast, no thromboembolic event was observed in patients with paroxysmal AF (4/64 vs 0/84, P = 0. 033).</p><p><b>CONCLUSION</b>Thromboembolic event rate related to CPVI is significantly higher in patients with persistent AF than that in patients with paroxysmal AF.</p>