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Войти в исследования Journal of cardiovascular electrophysiology · 2026
Incidence and Predictors of Cardiac Tamponade in Contemporary Thermal Catheter Ablation of Atrial Fibrillation.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Murata Kazuya, Miyazaki Shinsuke, Nitta Junichi, Inaba Osamu, Takahashi Atsushi, Yamashita Shu, Yamauchi Yasuteru, Nagata Yasutoshi, Mizukami Akira, Takahashi Yoshihide, Iwai Shinsuke, Hachiya Hitoshi, Ono Yuichi, Okada Hiroyuki, Suzuki Atsushi, Suzuki Makoto, Handa Keita, Sasano Tetsuo
Аннотация
BACKGROUND: Contributing factors to cardiac tamponade after contemporary thermal ablation remain poorly defined, especially in relation to ablation strategies. We aimed to clarify the incidence and identify the risk factors associated with cardiac tamponade following thermal atrial fibrillation (AF) ablation.
METHODS: Data from consecutive AF ablation procedures at 20 cardiovascular centers between 2022 and 2024 were analyzed.
RESULTS: Among 12 820 AF ablation procedures (mean age 68 ± 11 years; 8877 men; 6,963 paroxysmal AF; 9824 index procedures), radiofrequency and cryoballoon ablation were performed in 10 083 (78.6%) and 5884 (45.9%) procedures. Peri-procedural anticoagulant was a direct thrombin inhibitor (DTI) in 6051 (49.2%) procedures. Cavo-tricuspid isthmus, superior vena cava, mitral isthmus linear ablation, Vein of Marshall (VoM) ethanol infusion, and non-pulmonary vein AF trigger ablation were performed in 6590 (51.4%), 2834 (22.1%), 1138 (8.9%), 733 (5.7%), and 729 (5.7%) procedures, respectively. Cardiac tamponade occurred in 84 (0.64%) (0.59% after index and 0.80% after re-do) procedures. Among them, 61 (0.48%) procedures required pericardiocentesis with a median of 300 [167-500] mL of drainage, and 4 (0.03%) required surgical intervention. All patients recovered without sequelae. In the multivariable analysis, mitral isthmus linear ablation (Odds ratio [OR] = 4.230, 95% confidence interval [CI] = 2.525-7.059; p < 0.001) and paroxysmal AF (OR = 2.095, 95% CI = 1.265-3.470; p = 0.004) significantly increased the incidence of cardiac tamponade. In contrast, DTI use (OR = 0.415, 95% CI = 0.250-0.691; p = 0.001) significantly decreased the incidence.
CONCLUSIONS: The real-world incidence of cardiac tamponade during contemporary thermal AF ablation was 0.64%, with surgical intervention required in 0.03%. Lateral mitral isthmus ablation, paroxysmal AF, and lack of direct thrombin inhibitor use were independent predictors, with lateral mitral isthmus ablation being the strongest predictor.
METHODS: Data from consecutive AF ablation procedures at 20 cardiovascular centers between 2022 and 2024 were analyzed.
RESULTS: Among 12 820 AF ablation procedures (mean age 68 ± 11 years; 8877 men; 6,963 paroxysmal AF; 9824 index procedures), radiofrequency and cryoballoon ablation were performed in 10 083 (78.6%) and 5884 (45.9%) procedures. Peri-procedural anticoagulant was a direct thrombin inhibitor (DTI) in 6051 (49.2%) procedures. Cavo-tricuspid isthmus, superior vena cava, mitral isthmus linear ablation, Vein of Marshall (VoM) ethanol infusion, and non-pulmonary vein AF trigger ablation were performed in 6590 (51.4%), 2834 (22.1%), 1138 (8.9%), 733 (5.7%), and 729 (5.7%) procedures, respectively. Cardiac tamponade occurred in 84 (0.64%) (0.59% after index and 0.80% after re-do) procedures. Among them, 61 (0.48%) procedures required pericardiocentesis with a median of 300 [167-500] mL of drainage, and 4 (0.03%) required surgical intervention. All patients recovered without sequelae. In the multivariable analysis, mitral isthmus linear ablation (Odds ratio [OR] = 4.230, 95% confidence interval [CI] = 2.525-7.059; p < 0.001) and paroxysmal AF (OR = 2.095, 95% CI = 1.265-3.470; p = 0.004) significantly increased the incidence of cardiac tamponade. In contrast, DTI use (OR = 0.415, 95% CI = 0.250-0.691; p = 0.001) significantly decreased the incidence.
CONCLUSIONS: The real-world incidence of cardiac tamponade during contemporary thermal AF ablation was 0.64%, with surgical intervention required in 0.03%. Lateral mitral isthmus ablation, paroxysmal AF, and lack of direct thrombin inhibitor use were independent predictors, with lateral mitral isthmus ablation being the strongest predictor.