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Thromb Haemost
DOI: 10.1055/s-0044-1785519
Stroke, Systemic or Venous Thromboembolism

In-Hospital Pulmonary Arterial Embolism after Catheter Ablation of Over 45,000 Cardiac Arrhythmias: Individualized Case Analysis of Multicentric Data

Florian Doldi 
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
,
Nele Geßler
2   Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
,
Omar Anwar
2   Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
,
Ann-Kathrin Kahle 
3   Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
,
Katharina Scherschel
3   Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
,
Benjamin Rath
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
,
Julia Köbe
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
,
Philipp Sebastian Lange
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
,
Gerrit Frommeyer
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
,
Andreas Metzner
4   Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg, Hamburg, Germany
,
Christian Meyer
3   Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
,
Stephan Willems
2   Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
,
Karl-Heinz Kuck
2   Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
,
Lars Eckardt
1   Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
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Abstract

Objective and Background Data on incidence of in-hospital pulmonary embolisms (PE) after catheter ablation (CA) are scarce. To gain further insights, we sought to provide new findings through case-based analyses of administrative data.

Methods Incidences of PE after CA of supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter (AFlu), and ventricular tachycardias (VT) in three German tertiary centers between 2005 and 2020 were determined and coded by the G-DRG (German Diagnosis Related Groups System) and OPS (German Operation and Procedure Classification) systems. An administrative search was performed with a consecutive case-based analysis.

Results Overall, 47,344 ablations were analyzed (10,037 SVT; 28,048 AF; 6,252 AFlu; 3,007 VT). PE occurred in 14 (0.03%) predominantly female (n = 9; 64.3%) patients with a mean age of 55.3 ± 16.9 years, body mass index 26.2 ± 5.1 kg/m2, and left ventricular ejection fraction of 56 ± 13.6%. PE incidences were 0.05% (n = 5) for SVT, 0.02% (n = 5) for AF, and 0.13% (n = 4) for VT ablations. No patient suffered PE after AFlu ablation. Five patients (35.7%) with PE after CA had no prior indication for oral anticoagulation (OAC). Preprocedural international normalized ratio in PE patients was 1.2 ± 0.5. Most patients with PE following CA presented with symptoms the day after the procedure (n = 9) after intraprocedural heparin application of 12,943.2 ± 5,415.5 IU. PE treatment included anticoagulation with either phenprocoumon (n = 5) or non-vitamin K-dependent OAC (n = 9). Two patients with PE died after VT/AF ablation, respectively. The remaining patients were discharged without sequels.

Conclusion Over a 15-year period, incidence of PE after ablation is low, particularly low in patients with ablation for AF/AFlu. This is most likely due to stricter anticoagulation management in these patients compared with those receiving SVT/VT ablation procedures and could argue for continuation of OAC prior to ablation. Optimizing periprocedural anticoagulation management should be subject of further prospective trials.

Keywords

complications - pulmonary arterial embolism - ablation - arrhythmias


Publication History

Received: 17 November 2024

Accepted: 05 March 2024

Article published online:
31 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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