COMPLICATIONS OF RADIOFREQUENCY ABLATION - THE FRENCH EXPERIENCE

The multiplication Of the indication of radiofrequency for curative or palliative treatment of cardiac arrhythmias motivated the Rhythmology Working Group to set up a register of the complications related to th is technique. Five thousand six hundred and eighty nine cases from 19 French centres were recensed up to March 1996. There were 2 765 ablati ons of a Bundle of Kent, 1 579 ablations of slow pathways, 612 ablatio ns of atrial flutter, 25 ablations of atrial tachycardia, 200 ablation s of ventricular tachycardia and 499 ablations of the Bundle of His. E ighty five complications (1.5 %), two of which were lethal (0.04 %), w ere reported. The complications of catheterization (27% of all complic ations) were pneumothorax (n = 6), arterial trombosis (n = 3), Venous thrombosis with and without pulmonary embolism (n = 8), haematoma (n = 2), femoral pseudoaneurysm (n = 1), arteriovenous fistula (n = 1), in fection (n = 2), valvular disease with mitral or aortic regurgitation (n = 3). Other complications were specific to the ablation itself: ski n burns at the site of the patch (n = 2), ventricular fibrillation (n = 3), coronary events (n = 2), Vascular events (n = 2), tamponade (n = 12), one of which was lethal, and transient or permanent complete atr ioventricular block (n = 32) complicating ablation of antero and poste roseptal accessory pathways, atrial flutter and slow intranodal reentr y pathways (n = 25). One lethal cerebral haemorrhage occurred the day after an ablation procedure. It was not possible to identify a predict ive factor in these complications apart from the operator's experience . There were 1.4 % of complications in Kent bundle ablations, 1.9 % in ablation of slow pathway, 0.6; % in atrial flutter and tachycardia, 1 .5 % for ventricular tachycardia and 1.9 % for Bundle of His. The auth ors concluded that the prevalence of complications, though small with minimal risk of mortality (0.04 %), should incite physicians to reserv e this technique for symptomatic patients or those with potentially le thal arrhythmias.