Risks and complications of radiofrequency catheter ablation of cardiac arrhythmias

Radiofrequency catheter ablation has established itself as a first line the rapy for the curative treatment of many patients with spuraventricular or a trioventricular tachycardias and also for selected types of ventricular tac hycardia. The success rates of catheter ablation of various types of cardia c arrhythmias are impressively high. Procedure related complications cain b e attributed to the invasive nature of the technique (e.g., bleeding or oth er vascular complications, radiation exposure) but may also occur as a spec ific complication related to the type of intervention performed (e.g., comp lete AV-block following attempted modification of the AV-node). In patients undergoing radiofrequency ablation procedures, radiation exposure carries a small but measurable risk of malignancy and hereditary disorders. The ris k of fatal malignancy has been calculated to be approximately 1 parts per t housand per hour of fluoroscopy and the risk of significant hereditary diso rders approximately 10 per 1 million live births per hour fluoroscopy time. However, it is important to realize that these risks are age and sex depen dent being higher in young and/or female patients. For the physician perfor ming catheter ablation procedures no significant risks related to fluorosco py exposure may be expected as long as all established tools for protection are used. Based on the results of large single center studies and multicen ter investigations, complications during or after radiofrequency catheter a blation of supraventricular or atrioventricular arrhythmias may occur in 4- 5 % of cases. Seven complications (life threatening or permanently disablin g complications) may occur in approximately 1-2 % of patients treated. In p atients undergoing ablation of ventricular tachycardia, a higher incidence of total procedure related complications between 5-7 % and severe complicat ions (3-4 %) may be expected. The higher incidence of complications in pati ents with ventricular tachycardia when compared to catheter ablation of sup raventricular or atrioventricular tachycardia may be explained by the fact that many patients with ventricular tachycardia suffer from severe cardiova scular disease.