Thromboembolic complications of cardiac radiofrequency catheter ablation: A review of the reported incidence, pathogenesis and current research directions

Thromboembolic Complications of Cardiac RF Catheter Ablation. introduction: Radiofrequency catheter ablation (RFCA) has become established as an effec tive therapy for the treatment of many cardiac tachyarrhythmias, The princi ple limitation of conventional RFCA continues to be the risk of thromboembo lism. This risk is of particular concern for the ongoing development of the catheter maze procedure for the treatment of atrial fibrillation, which cu rrently involves the creation of extensive linear lesions in the left atriu m, Methods and Results: A Medline search of the literature over the last ten y ears was performed. Focused review of the reported thromboembolic complicat ions of RFCA indicates an overall incidence of 0.6%. However, the risk is i ncreased when ablation is performed in the left heart (1.8% to 2%) and for ventricular tachycardia (2.8%). It is of concern that intravenous heparin a nd the use of temperature feedback; to control radiofrequency current do no t eliminate the risk of thromboembolic events. Conclusion: The thromboembolic complications of RFCA are not eliminated by the treatment of intravenous herapin and mode of temperature control during ablation. Potential approaches to further reduce the risk of thromboemboli sm include the adjunctive administration of specific inhibitors of platelet activation and aggregation, intraprocedural intracardiac echocardiography, irrigated radiofrequency ablation, and cryoablation catheter systems.