Atrial Fibrillation Ablation: Reducing Cardiac Tamponade

Atrial Fibrillation Ablation Techniques
Atrial Fibrillation Ablation Techniques
Patients treated with balloon ablation for atrial fibrillation had the lowest rates of cardiac tamponade.

Use of balloon catheters in atrial fibrillation (AF) ablation reduced the risk of cardiac tamponade, according to research published in JACC: Clinical Electrophysiology.

While catheter ablation is an effective treatment for AF, the procedure is associated with significant complications. To mitigate these possible complications, manual left atrial and “point-by-point” radiofrequency current energy ablation are used to achieve pulmonary vein isolation (PVI). More recently, balloon-based energy deployment has been implemented.

K.R. Julian Chun, MD, of Cardioangiologisches Centrum Bethanien in Frankfurt, Germany, and colleagues conducted a study using different AF ablation technologies and strategies to identify cardiac tamponade predictors.

In this study, a total of 3000 AF ablations were performed. The researchers divided patients into 2 groups: A (n=2125; radiofrequency current) and B (n=875; balloon). Within group A, patients were divided into PVI only (n=1559; A1) and PVI plus additional ablation (A2; n=566). Patients in group B patients had either cryoballoon (n=589) or laser balloon (n=289).

Cardiac tamponade occurred at a rate of 1.1%. In group B, the rate was 0.1% vs 1.5% in group A (P =.001). The reduced rate remained in group B vs group A1-PVI only (0.8% vs 0.1%; P =.024), while group A2-PVI plus additional ablation had the greatest risk of cardiac tamponade (3.2%). Radiofrequency ablation beyond PVI was a predictor of cardiac tamponade, and this extensive ablation may lead to an increased risk of perforation. However, the risk of cardiac tamponade was low for those in whom repeat PVI-only procedure was performed.

Fluoroscopy and procedure times were shorter in group A compared with group B, but acute electrical PVI was nearly identical (100% and 99%, respectively). Apart from cardiac tamponade, there was an increased complication risk in group B vs group A (2.9% vs 5.4%), mainly due to phrenic nerve palsy (1.7% total, cryoballoon: 1.9%, and laser balloon: 1.4%; P =.616).

Dr Chun and colleagues noted that their findings appear to match recently published data from the Fire and Ice trial. Cardiac tamponade rates were also higher in the radiofrequency ablation group, but they did not reach statistical significance. The present study, with a large enough patient cohort, did demonstrate a statistically significant reduced risk of cardiac tamponade using balloon ablation.

One limitation of this study is that it was a retrospective analysis (vs a prospective randomized trial). In addition, while all AF ablation operators followed the same approach and had been extensively trained in high-volume AF centers, different versions of 3D navigation software have been developed since 2010 (the starting year of this analysis). Therefore, potential data bias may have been introduced because of learning curve effects.

To confirm safety and efficacy of different ablation techniques, the authors wrote that more prospective comparative data are necessary.

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Disclosures: Drs Chun, Furnkranz, and Bordignon received speaker’s honoraria from Medtronic. Dr Chun also received speaker’s honoraria from Biosense Webster and Dr Schmidt received speaker’s honoraria from Cardiofocus.


Chun KRJ, Perrotta L, Bordignon S, et al. Complications in catheter ablation of atrial fibrillation in 3000 consecutive procedures: balloon vs radiofrequency current ablation. JACC Clin Electrophysiol. 2016. doi:10.1016/j.jacep.2016.07.002.