Complications and adverse events after atrial fibrillation catheter ablation procedures: a Nationwide Cohort Study

Abstract Background Catheter ablation is a well-established treatment to prevent atrial fibrillation (AF) recurrences and to relieve symptoms. More information is needed on the occurrence of adverse events following the procedure. Purpose We investigated the incidence of new-onset adverse events after first-time AF catheter ablation procedures in Finland between 2012-2016. Methods Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a registry-linkage study including all patients with AF in Finland between 2007-2018. Results A total of 3075 first-time AF ablations were identified between 2012-2016. The mean age of the patients was 57.8 years, 70.6 % were men, and the mean CHA2DS2-VA score was 1.4. All-cause mortality was 0.1% (2 patients) at the three-month follow-up and 0.3% (9 patients) at the two-year follow-up. At the three-month follow-up, 71 (2.3%) patients had suffered a new-onset adverse event, including major bleeding, myocardial infarction, heart failure, ischaemic stroke or TIA, pericardial complication (including pericarditis, hemopericardium, or the need for pericardiocentesis or surgical pericardiotomy), pneumo- or hemothorax, or death from any cause (Figure 1, Table 1). Moreover, during the two-year follow-up, 217 (7.1%) patients experienced at least one of the aforementioned adverse events. When examined with binary logistic regression analysis, age 70 years or older, hypertension, and previous ischaemic stroke or TIA at baseline were associated with the occurrence of new-onset heart failure at the two-year follow-up and diabetes was associated with new-onset heart failure at the three-month follow-up (Table 2). Furthermore, previous heart failure was related to higher odds of new-onset major bleeding whereas previous major bleeding was linked to new-onset myocardial infarction at the two-year follow-up. Additionally, being 70 years or older was associated with an increased risk of death from any cause during the two-year follow-up. Sex was not associated with adverse events after AF ablation. Conclusions Catheter ablation for AF proved to be a safe treatment in terms of short-term complications. However, at the two-year follow-up, 7.1% of the patients treated with first-time AF ablation developed a new-onset adverse event. This highlights the need for continuous post-procedural monitoring and evaluation of long-term outcomes, especially in elderly patients and those with hypertension, previous stroke or TIA, bleedings, and heart failure.